U.S. patent application number 10/998351 was filed with the patent office on 2005-09-22 for electrical devices and anti-scarring agents.
This patent application is currently assigned to Angiotech International AG. Invention is credited to Gravett, David M., Hunter, William L., Maiti, Arpita, Toleikis, Philip M..
Application Number | 20050209665 10/998351 |
Document ID | / |
Family ID | 34637512 |
Filed Date | 2005-09-22 |
United States Patent
Application |
20050209665 |
Kind Code |
A1 |
Hunter, William L. ; et
al. |
September 22, 2005 |
Electrical devices and anti-scarring agents
Abstract
Electrical devices (e.g., cardiac rhythm management and
neurostimulation devices) for contact with tissue are used in
combination with an anti-scarring agent (e.g., a cell cycle
inhibitor) in order to inhibit scarring that may otherwise occur
when the devices are implanted within an animal.
Inventors: |
Hunter, William L.;
(Vancouver, CA) ; Gravett, David M.; (Vancouver,
CA) ; Toleikis, Philip M.; (Vancouver, CA) ;
Maiti, Arpita; (Vancouver, CA) |
Correspondence
Address: |
SEED INTELLECTUAL PROPERTY LAW GROUP PLLC
701 FIFTH AVENYUE, SUITE 6300
SEATTLE
WA
98104-7092
US
|
Assignee: |
Angiotech International AG
Zug
CH
|
Family ID: |
34637512 |
Appl. No.: |
10/998351 |
Filed: |
November 26, 2004 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
10998351 |
Nov 26, 2004 |
|
|
|
10996355 |
Nov 22, 2004 |
|
|
|
10996355 |
Nov 22, 2004 |
|
|
|
10986230 |
Nov 10, 2004 |
|
|
|
10996355 |
Nov 22, 2004 |
|
|
|
10986231 |
Nov 10, 2004 |
|
|
|
60586861 |
Jul 9, 2004 |
|
|
|
60578471 |
Jun 9, 2004 |
|
|
|
60526541 |
Dec 3, 2003 |
|
|
|
60525226 |
Nov 24, 2003 |
|
|
|
60523908 |
Nov 20, 2003 |
|
|
|
60524023 |
Nov 20, 2003 |
|
|
|
Current U.S.
Class: |
607/115 |
Current CPC
Class: |
A61L 2300/416 20130101;
A61L 2300/432 20130101; A61L 2300/45 20130101; A61L 27/3641
20130101; A61P 29/00 20180101; A61P 43/00 20180101; A61P 9/00
20180101; A61P 37/02 20180101; A61P 7/02 20180101; A61P 41/00
20180101; A61L 31/16 20130101; A61P 19/02 20180101; A61P 35/00
20180101; A61N 1/05 20130101; A61N 1/372 20130101; A61K 38/17
20130101; A61L 2300/404 20130101; A61P 31/00 20180101; A61L 27/54
20130101 |
Class at
Publication: |
607/115 |
International
Class: |
A61N 001/00 |
Claims
1.-11691. (canceled)
11692. A medical device, comprising a cardiac rhythm management
device (i.e., an electrical device) and an anti-scarring agent or a
composition comprising an anti-scarring agent, wherein the agent
inhibits scarring between the medical device and the host into
which the medical device is implanted.
11693. The medical device of claim 11692 wherein the agent inhibits
cell regeneration.
11694. The medical device of claim 11692 wherein the agent inhibits
angiogenesis.
11695. The medical device of claim 11692 wherein the agent inhibits
fibroblast migration.
11696. The medical device of claim 11692 wherein the agent inhibits
fibroblast proliferation.
11697. The medical device of claim 11692 wherein the agent inhibits
deposition of extracellular matrix.
11698. The medical device of claim 11692 wherein the agent inhibits
tissue remodeling.
11699. (canceled)
11700. (canceled)
11701. The medical device of claim 11692 wherein the agent is a
chemokine receptor antagonist.
11702. The medical device of claim 11692 wherein the agent is a
cell cycle inhibitor.
11703. The medical device of claim 11692 wherein the agent is a
taxane.
11704. The medical device of claim 11692 wherein the agent is an
anti-microtubule agent.
11705. The medical device of claim 11692 wherein the agent is
paclitaxel.
11706. The medical device of claim 11692 wherein the agent is not
paclitaxel.
11707. The medical device of claim 11692 wherein the agent is an
analogue or derivative of paclitaxel.
11708. The medical device of claim 11692 wherein the agent is a
vinca alkaloid.
11709. The medical device of claim 11692 wherein the agent is
camptothecin or an analogue or derivative thereof.
11710. The medical device of claim 11692 wherein the agent is a
podophyllotoxin.
11711. The medical device of claim 11692 wherein the agent is a
podophyllotoxin, wherein the podophyllotokin is etoposide or an
analogue or derivative thereof.
11712. The medical device of claim 11692 wherein the agent is an
anthracycline.
11713. The medical device of claim 11692 wherein the agent is an
anthracycline, wherein the anthracycline is doxorubicin or an
analogue or derivative thereof.
11714. The medical device of claim 11692 wherein the agent is an
anthracycline, wherein the anthracycline is mitoxantrone or an
analogue or derivative thereof.
11715. The medical device of claim 11692 wherein the agent is a
platinum compound.
11716. The medical device of claim 11692 wherein the agent is a
nitrosourea.
11717. The medical device of claim 11692 wherein the agent is a
nitroimidazole.
11718. The medical device of claim 11692 wherein the agent is a
folic acid antagonist.
11719. The medical device of claim 11692 wherein the agent is a
cytidine analogue.
11720. The medical device of claim 11692 wherein the agent is a
pyrimidine analogue.
11721. The medical device of claim 11692 wherein the agent is a
fluoropyrimidine analogue.
11722. The medical device of claim 11692 wherein the agent is a
purine analogue.
11723. The medical device of claim 11692 wherein the agent is a
nitrogen mustard or an analogue or derivative thereof.
11724.-11896. (canceled)
11897. The medical device of claim 11692, further comprising a
second pharmaceutically active agent.
11898. (canceled)
11899. The medical device of claim 11692, further comprising an
agent that inhibits infection.
11900.-12320. (canceled)
12321. A method for inhibiting scarring comprising placing a
cardiac rhythm management device (i.e., an electrical device) and
an anti-scarring agent or a composition comprising an anti-scarring
agent into an animal host, wherein the agent inhibits scarring.
12322. The method of claim 12321 wherein the agent inhibits cell
regeneration.
12323. The method of claim 12321 wherein the agent inhibits
angiogenesis.
12324. The method of claim 12321 wherein the agent inhibits
fibroblast migration.
12325. The method of claim 12321 wherein the agent inhibits
fibroblast proliferation.
12326. The method of claim 12321 wherein the agent inhibits
deposition of extracellular matrix.
12327. The method of claim 12321 wherein the agent inhibits tissue
remodeling.
12328. (canceled)
12329. (canceled)
12330. The method of claim 12321 wherein the agent is a chemokine
receptor antagonist.
12331. The method of claim 12321 wherein the agent is a cell cycle
inhibitor.
12332. The method of claim 12321 wherein the agent is a taxane.
12333. The method of claim 12321 wherein the agent is an
anti-microtubule agent.
12334. The method of claim 12321 wherein the agent is
paclitaxel.
12335. The method of claim 12321 wherein the agent is not
paclitaxel.
12336. The method of claim 12321 wherein the agent is an analogue
or derivative of paclitaxel.
12337. The method of claim 12321 wherein the agent is a vinca
alkaloid.
12338. The method of claim 12321 wherein the agent is camptothecin
or an analogue or derivative thereof.
12339. The method of claim 12321 wherein the agent is a
podophyllotoxin.
12340. The method of claim 12321 wherein the agent is a
podophyllotoxin, wherein the podophyllotoxin is etoposide or an
analogue or derivative thereof.
12341. The method of claim 12321 wherein the agent is an
anthracycline.
12342. The method of claim 12321 wherein the agent is an
anthracycline, wherein the anthracycline is doxorubicin or an
analogue or derivative thereof.
12343. The method of claim 12321 wherein the agent is an
anthracycline, wherein the anthracycline is mitoxantrone or an
analogue or derivative thereof.
12344. The method of claim 12321 wherein the agent is a platinum
compound.
12345. The method of claim 12321 wherein the agent is a
nitrosourea.
12346. The method of claim 12321 wherein the agent is a
nitroimidazole.
12347. The method of claim 12321 wherein the agent is a folic acid
antagonist.
12348. The method of claim 12321 wherein the agent is a cytidine
analogue.
12349. The method of claim 12321 wherein the agent is a pyrimidine
analogue.
12350. The method of claim 12321 wherein the agent is a
fluoropyrimidine analogue.
12351. The method of claim 12321 wherein the agent is a purine
analogue.
12352. The method of claim 12321 wherein the agent is a nitrogen
mustard or an analogue or derivative thereof.
12353.-12499. (canceled)
12500. The method of claim 12321, wherein the composition further
comprises a second pharmaceutically active agent.
12501. (canceled)
12502. The method of claim 12321, wherein the composition further
comprises an agent that inhibits infection.
12503.-12973. (canceled)
12974. A method for making a medical device comprising: combining a
cardiac rhythm management device (i.e., an electrical device) and
an anti-scarring agent or a composition comprising an anti-scarring
agent, wherein the agent inhibits scarring between the device and a
host into which the device is implanted.
12975. The method of claim 12974 wherein the agent inhibits cell
regeneration.
12976. The method of claim 12974 wherein the agent inhibits
angiogenesis.
12977. The method of claim 12974 wherein the agent inhibits
fibroblast migration.
12978. The method of claim 12974 wherein the agent inhibits
fibroblast proliferation.
12979. The method of claim 12974 wherein the agent inhibits
deposition of extracellular matrix.
12980. The method of claim 12974 wherein the agent inhibits tissue
remodeling.
12981. (canceled)
12982. (canceled)
12983. The method of claim 12974 wherein the agent is a chemokine
receptor antagonist.
12984. The method of claim 12974 wherein the agent is a cell cycle
inhibitor.
12985. The method of claim 12974 wherein the agent is a taxane.
12986. The method of claim 12974 wherein the agent is an
anti-microtubule agent.
12987. The method of claim 12974 wherein the agent is
paclitaxel.
12988. The method of claim 12974 wherein the agent is not
paclitaxel.
12989. The method of claim 12974 wherein the agent is an analogue
or derivative of paclitaxel.
12990. The method of claim 12974 wherein the agent is a vinca
alkaloid.
12991. The method of claim 12974 wherein the agent is camptothecin
or an analogue or derivative thereof.
12992. The method of claim 12974 wherein the agent is a
podophyllotoxin.
12993. The method of claim 12974 wherein the agent is a
podophyllotoxin, wherein the podophyllotoxin is etoposide or an
analogue or derivative thereof.
12994. The method of claim 12974 wherein the agent is an
anthracycline.
12995. The method of claim 12974 wherein the agent is an
anthracycline, wherein the anthracycline is doxorubicin or an
analogue or derivative thereof.
12996. The method of claim 12974 wherein the agent is an
anthracycline, wherein the anthracycline is mitoxantrone or an
analogue or derivative thereof.
12997. The method of claim 12974 wherein the agent is a platinum
compound.
12998. The method of claim 12974 wherein the agent is a
nitrosourea.
12999. The method of claim 12974 wherein the agent is a
nitroimidazole.
13000. The method of claim 12974 wherein the agent is a folic acid
antagonist.
13001. The method of claim 12974 wherein the agent is a cytidine
analogue.
13002. The method of claim 12974 wherein the agent is a pyrimidine
analogue.
13003. The method of claim 12974 wherein the agent is a
fluoropyrimidine analogue.
13004. The method of claim 12974 wherein the agent is a purine
analogue.
13005. The method of claim 12974 wherein the agent is a nitrogen
mustard or an analogue or derivative thereof.
13006.-13181. (canceled)
13182. The method of claim 12974, wherein the medical device
further comprises a second pharmaceutically active agent.
13183. (canceled)
13184. The method of claim 12974 wherein the medical device further
comprises an agent that inhibits infection.
13185.-13305. (canceled)
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a Continuation-in-Part of U.S.
application Ser. No. 10/986,231, filed Nov. 10, 2004; and U.S.
application Ser. No. 10/986,230, filed Nov. 10, 2004. This
application also claims the benefit under 35 U.S.C. 119(e) of U.S.
Provisional Application Ser. Nos. 60/586,861, filed Jul. 9, 2004;
60/578,471, filed Jun. 9, 2004; 60/526,541, filed Dec. 3, 2003;
60/525,226, filed Nov. 24, 2003; 60/523,908, filed Nov. 20, 2003;
and 60/524,023, filed Nov. 20, 2003, which applications are
incorporated herein by reference in their entireties.
BACKGROUND OF THE INVENTION
[0002] 1. Field of the Invention
[0003] The present invention relates generally to pharmaceutical
compositions, methods and devices, and more specifically, to
compositions and methods for preparing and using medical implants
to make them resistant to overgrowth by inflammatory, fibrous and
glial scar tissue.
[0004] 2. Description of the Related Art
[0005] Medical devices having electrical components, such as
electrical pacing or stimulating devices, can be implanted in the
body to provide electrical conduction to the central and peripheral
nervous system (including the autonomic system), cardiac muscle
tissue (including myocardial conduction pathways), smooth muscle
tissue and skeletal muscle tissue. These electrical impulses are
used to treat many bodily dysfunctions and disorders by blocking,
masking, stimulating, or replacing electrical signals within the
body. Examples include pacemaker leads used to maintain the normal
rhythmic beating of the heart; defibrillator leads used to
"re-start" the heart when it stops beating; peripheral nerve
stimulating devices to treat chronic pain; deep brain electrical
stimulation to treat conditions such as tremor, Parkinson's
disease, movement disorders, epilepsy, depression and psychiatric
disorders; and vagal nerve stimulation to treat epilepsy,
depression, anxiety, obesity, migraine and Alzheimer's Disease.
[0006] The clinical function of an electrical device such as a
cardiac pacemaker lead, neurostimulation lead, or other electrical
lead depends upon the device being able to effectively maintain
intimate anatomical contact with the target tissue (typically
electrically excitable cells such as muscle or nerve) such that
electrical conduction from the device to the tissue can occur.
Unfortunately, in many instances when these devices are implanted
in the body, they are subject to a "foreign body" response from the
surrounding host tissues. The body recognizes the implanted device
as foreign, which triggers an inflammatory response followed by
encapsulation of the implant with fibrous connective tissue (or
glial tissue--called "gliosis"--when it occurs within the central
nervous system). Scarring (i.e., fibrosis or gliosis) can also
result from trauma to the anatomical structures and tissue
surrounding the implant during the implantation of the device.
Lastly, fibrous encapsulation of the device can occur even after a
successful implantation if the device is manipulated (some patients
continuously "fiddle" with a subcutaneous implant) or irritated by
the daily activities of the patient. When scarring occurs around
the implanted device, the electrical characteristics of the
electrode-tissue interface degrade, and the device may fail to
function properly. For example, it may require additional
electrical current from the lead to overcome the extra resistance
imposed by the intervening scar (or glial) tissue. This can shorten
the battery life of an implant (making more frequent removal and
re-implantation necessary), prevent electrical conduction
altogether (rendering the implant clinically ineffective) and/or
cause damage to the target tissue. Additionally, the surrounding
tissue may be inadvertently damaged from the inflammatory foreign
body response, which can result in loss of function or tissue
necrosis.
BRIEF SUMMARY OF THE INVENTION
[0007] Briefly stated, the present invention discloses
pharmaceutical agents which inhibit one or more aspects of the
production of excessive fibrous (scar) or glial tissue. In one
aspect, the present invention provides compositions for delivery of
selected therapeutic agents via medical implants or implantable
electrical medical devices, as well as methods for making and using
these implants and devices. Compositions and methods are described
for coating electrical medical devices and implants with
drug-delivery compositions such that the pharmaceutical agent is
delivered in therapeutic levels over a period sufficient to prevent
the device electrode from being encapsulated in fibrous or glial
tissue and to allow normal electrical conduction to occur.
Alternatively, locally administered compositions (e.g., topicals,
injectables, liquids, gels, sprays, microspheres, pastes, wafers)
containing an inhibitor of fibrosis (or gliosis) are described that
can be applied to the tissue adjacent to the electrical medical
device or implant, such that the pharmaceutical agent is delivered
in therapeutic levels over a period sufficient to prevent the
device electrode from being encapsulated in fibrous or glial
tissue. And finally, numerous specific cardiac and neurological
implants and devices are described that produce superior clinical
results as a result of being coated with agents that reduce
excessive scarring and fibrous (or glial) tissue accumulation as
well as other related advantages.
[0008] Within one aspect of the invention, drug-coated or
drug-impregnated implants and medical devices are provided which
reduce fibrosis or gliosis in the tissue surrounding the electrical
device or implant, or inhibit scar development on the
device/implant surface (particularly the electrical lead), thus
enhancing the efficacy of the procedure. For example, it may
require additional electrical current from the lead to overcome the
extra resistance imposed by the intervening scar (or glial) tissue.
This can shorten the battery life of an implant (making more
frequent removal and re-implantation necessary), prevent electrical
conduction altogether (rendering the implant clinically
ineffective) and/or cause damage to the target tissue. Within
various embodiments, fibrosis or gliosis is inhibited by local or
systemic release of specific pharmacological agents that become
localized to the adjacent tissue.
[0009] The repair of tissues following a mechanical or surgical
intervention, such as the implantation of an electrical device,
involves two distinct processes: (1) regeneration (the replacement
of injured cells by cells of the same type and (2) fibrosis (the
replacement of injured cells by connective tissue). There are four
general components to the process of fibrosis (or scarring)
including: formation of new blood vessels (angiogenesis), migration
and proliferation of connective tissue cells (such as fibroblasts
or smooth muscle cells), deposition of extracellular matrix (ECM),
and remodeling (maturation and organization of the fibrous tissue).
As utilized herein, "inhibits (reduces) fibrosis" should be
understood to refer to agents or compositions which decrease or
limit the formation of fibrous tissue (i.e., by reducing or
inhibiting one or more of the processes of angiogenesis, connective
tissue cell migration or proliferation, ECM production, and/or
remodeling). In addition, numerous therapeutic agents described in
this invention may have the additional benefit of also reducing
tissue regeneration where appropriate.
[0010] It should be noted that in implantation procedures that
cause injuries to the central nervous system (CNS), fibrosis is
replaced by a process called gliosis (the replacement of injured or
dead cells with glial tissue). Glial cells form the supporting
tissue of the CNS and are comprised of macroglia (astrocytes,
oligodendrocytes, ependyma cells) and microglia cells. Of these
cell types, astrocytes are the principle cells responsible for
repair and scar formation in the brain and spinal cord. Gliosis is
the most important indicator of CNS damage and consists of
astrocyte hypertrophy (increase in size) and hyperplasia (increase
in cell number as a result of cell division) in response to injury
or trauma, such as that caused by the implantation of a medical
device. Astrocytes are responsible for phagocytosing dead or
damaged tissue and repairing the injury with glial tissue and thus,
serve a similar role to that performed by fibroblasts in scarring
outside the brain. In medical devices implanted into the CNS, it is
the hypertrophy and proliferation of astrocytes (gliosis) that
leads to the formation of a "scar-like" capsule around the implant
which can interfere with electrical conduction from the device to
the neuronal tissue.
[0011] Within certain embodiments of the invention, an implant or
device is adapted to release an agent that inhibits fibrosis or
gliosis through one or more of the mechanisms sited herein. Within
certain other embodiments of the invention, an implant or device
contains an agent that while remaining associated with the implant
or device, inhibits fibrosis between the implant or device and the
tissue where the implant or device is placed by direct contact
between the agent and the tissue surrounding the implant or
device.
[0012] Within related aspects of the present invention, cardiac and
neurostimulation devices are provided comprising an implant or
device, wherein the implant or device releases an agent which
inhibits fibrosis (or gliosis) in vivo. "Release of an agent"
refers to any statistically significant presence of the agent, or a
subcomponent thereof, which has disassociated from the
implant/device and/or remains active on the surface of (or within)
the device/implant. Within yet other aspects of the present
invention, methods are provided for manufacturing a medical device
or implant, comprising the step of coating (e.g., spraying,
dipping, wrapping, or administering drug through) a medical device
or implant. Additionally, the implant or medical device can be
constructed so that the device itself is comprised of materials
which inhibit fibrosis in or around the implant. A wide variety of
electrical medical devices and implants may be utilized within the
context of the present invention, depending on the site and nature
of treatment desired.
[0013] Within various embodiments of the invention, the implant or
device is further coated with a composition or compound, which
delays the onset of activity of the fibrosis-inhibiting (or
gliosis-inhibiting) agent for a period of time after implantation.
Representative examples of such agents include heparin, PLGA/MePEG,
PLA, and polyethylene glycol. Within further embodiments, the
fibrosis-inhibiting (or gliosis-inhibiting) implant or device is
activated before, during, or after deployment (e.g., an inactive
agent on the device is first activated to one that reduces or
inhibits an in vivo fibrotic or gliotic reaction).
[0014] Within various embodiments of the invention, the tissue
surrounding the implant or device is treated with a composition or
compound that contains an inhibitor of fibrosis or gliosis. Locally
administered compositions (e.g., topicals, injectables, liquids,
gels, sprays, microspheres, pastes, wafers) or compounds containing
an inhibitor of fibrosis (or gliosis) are described that can be
applied to the surface of, or infiltrated into, the tissue adjacent
to the electrical medical device or implant, such that the
pharmaceutical agent is delivered in therapeutic levels over a
period sufficient to prevent the device electrode from being
encapsulated in fibrous or glial tissue. This can be done in lieu
of coating the device or implant with a fibrosis/gliosis-inhibitor,
or done in addition to coating the device or implant with a
fibrosis/gliosis-inhibitor. The local administration of the
fibrosis/gliosis-inhibiting agent can occur prior to, during, or
after implantation of the electrical device itself.
[0015] Within various embodiments of the invention, an electrical
device or implant is coated on one aspect, portion or surface with
a composition which inhibits fibrosis, as well as being coated with
a composition or compound which promotes scarring on another
aspect, portion or surface of the device (i.e., to affix the body
of the device into a particular anatomical space). Representative
examples of agents that promote fibrosis and scarring include silk,
silica, crystalline silicates, bleomycin, quartz dust, neomycin,
talc, metallic beryllium and oxides thereof, retinoic acid
compounds, copper, leptin, growth factors, a component of
extracellular matrix; fibronectin, collagen, fibrin, or fibrinogen,
polylysine, poly(ethylene-co-vinylacetate), chitosan,
N-carboxybutylchitosan, and RGD proteins; vinyl chloride or a
polymer of vinyl chloride; an adhesive selected from the group
consisting of cyanoacrylates and crosslinked poly(ethylene
glycol)-methylated collagen; an inflammatory cytokine (e.g.,
TGF.beta., PDGF, VEGF, bFGF, TNF.alpha., NGF, GM-CSF, IGF-1, IL-1,
IL-1-.beta., IL-8, IL-6, and growth hormone); connective tissue
growth factor (CTGF) as well as analogues and derivatives
thereof.
[0016] Also provided by the present invention are methods for
treating patients undergoing surgical, endoscopic or minimally
invasive therapies where an electrical device or implant is placed
as part of the procedure. As utilized herein, it should be
understood that "inhibits fibrosis or gliosis" refers to a
statistically significant decrease in the amount of scar tissue in
or around the device or an improvement in the interface between the
electrical device or implant and the tissue, which may or may not
lead to a permanent prohibition of any complications or failures of
the device/implant.
[0017] The pharmaceutical agents and compositions are utilized to
create novel drug-coated implants and medical devices that reduce
the foreign body response to implantation and limit the growth of
reactive tissue on the surface of, or around in the tissue
surrounding the device, such that performance is enhanced.
Electrical medical devices and implants coated with selected
pharmaceutical agents designed to prevent scar tissue overgrowth
and improve electrical conduction can offer significant clinical
advantages over uncoated devices.
[0018] For example, in one aspect the present invention is directed
to electrical stimulatory devices that comprise a medical implant
and at least one of (i) an anti-scarring agent and (ii) a
composition that comprises an anti-scarring agent. The agent is
present so as to inhibit scarring that may otherwise occur when the
implant is placed within an animal. In another aspect the present
invention is directed to methods wherein both an implant and at
least one of (i) an anti-scarring agent and (ii) a composition that
comprises an anti-scarring agent, are placed into an animal, and
the agent inhibits scarring that may otherwise occur. These and
other aspects of the invention are summarized below.
[0019] Thus, in various independent aspects, the present invention
provides a device, comprising a cardiac or neurostimulator implant
and an anti-scarring agent or a composition comprising an
anti-scarring agent, wherein the agent inhibits scarring. These and
other devices are described in more detail herein.
[0020] In each of the aforementioned devices, in separate aspects,
the present invention provides that: the agent is a cell cycle
inhibitor; the agent is an anthracycline; the agent is a taxane;
the agent is a podophyllotoxin; the agent is an immunomodulator;
the agent is a heat shock protein 90 antagonist; the agent is a
HMGCoA reductase inhibitor; the agent is an inosine monophosphate
dehydrogenase inhibitor; the agent is an NF kappa B inhibitor; the
agent is a P38 MAP kinase inhibitor. These and other agents are
described in more detail herein.
[0021] In additional aspects, for each of the aforementioned
devices combined with each of the aforementioned agents, it is, for
each combination, independently disclosed that the agent may be
present in a composition along with a polymer. In one embodiment of
this aspect, the polymer is biodegradable. In another embodiment of
this aspect, the polymer is non-biodegradable. Other features and
characteristics of the polymer, which may serve to describe the
present invention for every combination of device and agent
described above, are set forth in greater detail herein.
[0022] In addition to devices, the present invention also provides
methods. For example, in additional aspects of the present
invention, for each of the aforementioned devices, and for each of
the aforementioned combinations of the devices with the
anti-scarring (or anti-gliotic) agents, the present invention
provides methods whereby a specified device is implanted into an
animal, and a specified agent associated with the device inhibits
scarring (or gliosis) that may otherwise occur. Each of the devices
identified herein may be a "specified device", and each of the
anti-scarring agents identified herein may be an "anti-scarring
agent", where the present invention provides, in independent
embodiments, for each possible combination of the device and the
agent.
[0023] The agent may be associated with the device prior to the
device being placed within the animal. For example, the agent (or
composition comprising the agent) may be coated onto an implant,
and the resulting device then placed within the animal. In
addition, or alternatively, the agent may be independently placed
within the animal in the vicinity of where the device is to be, or
is being, placed within the animal. For example, the agent may be
sprayed or otherwise placed onto, adjacent to, and/or within the
tissue that will be contacting the medical implant or may otherwise
undergo scarring. To this end, the present invention provides
placing a cardiac or neurostimulation implant and an anti-scarring
(or anti-gliosis) agent or a composition comprising an
anti-scarring (or anti-gliosis) agent into an animal host, wherein
the agent inhibits scarring or gliosis.
[0024] In each of the aforementioned methods, in separate aspects,
the present invention provides that: the agent is a cell cycle
inhibitor; the agent is an anthracycline; the agent is a taxane;
the agent is a podophyllotoxin; the agent is an immunomodulator;
the agent is a heat shock protein 90 antagonist; the agent is a
HMGCOA reductase inhibitor; the agent is an inosine monophosphate
dehydrogenase inhibitor; the agent is an NF kappa B inhibitor; the
agent is a P38 MAP kinase inhibitor. These and other agents which
can inhibit fibrosis and gliosis are described in more detail
herein.
[0025] In additional aspects, for each of the aforementioned
methods used in combination with each of the aforementioned agents,
it is, for each combination, independently disclosed that the agent
may be present in a composition along with a polymer. In one
embodiment of this aspect, the polymer is biodegradable. In another
embodiment of this aspect, the polymer is non-biodegradable. Other
features and characteristics of the polymer, which may serve to
describe the present invention for every combination of device and
agent described above, are set forth in greater detail herein.
[0026] These and other aspects of the present invention will become
evident upon reference to the following detailed description and
attached drawings. In addition, various references are set forth
herein which describe in more detail certain procedures and/or
compositions (e.g., polymers), and are therefore incorporated by
reference in their entirety.
BRIEF DESCRIPTION OF THE DRAWINGS
[0027] FIG. 1 is a diagram showing how a cell cycle inhibitor acts
at one or more of the steps in the biological pathway.
[0028] FIG. 2 is a graph showing the results for the screening
assay for assessing the effect of mitoxantrone on nitric oxide
production by THP-1 macrophages.
[0029] FIG. 3 is a graph showing the results for the screening
assay for assessing the effect of Bay 11-7082 on TNF-alpha
production by THP-1 macrophages.
[0030] FIG. 4 is a graph showing the results for the screening
assay for assessing the effect of rapamycin concentration for
TNF.alpha. production by THP-1 macrophages.
[0031] FIG. 5 is graph showing the results of a screening assay for
assessing the effect of mitoxantrone on proliferation of human
fibroblasts.
[0032] FIG. 6 is graph showing the results of a screening assay for
assessing the effect of rapamycin on proliferation of human
fibroblasts.
[0033] FIG. 7 is graph showing the results of a screening assay for
assessing the effect of paclitaxel on proliferation of human
fibroblasts.
[0034] FIG. 8 is a picture that shows an uninjured carotid artery
from a rat balloon injury model.
[0035] FIG. 9 is a picture that shows an injured carotid artery
from a rat balloon injury model.
[0036] FIG. 10 is a picture that shows a paclitaxel/mesh treated
carotid artery in a rat balloon injury model.
[0037] FIG. 11A schematically depicts the transcriptional
regulation of matrix metalloproteinases.
[0038] FIG. 11B is a blot which demonstrates that IL-1 stimulates
AP-1 transcriptional activity.
[0039] FIG. 11C is a graph which shows that IL-1 induced binding
activity decreased in lysates from chondrocytes which were
pretreated with paclitaxel.
[0040] FIG. 11D is a blot which shows that IL-1 induction increases
collagenase and stromelysin in RNA levels in chondrocytes, and that
this induction can be inhibited by pretreatment with
paclitaxel.
[0041] FIGS. 12A-H are blots that show the effect of various
anti-microtubule agents in inhibiting collagenase expression.
[0042] FIG. 13 is a graph showing the results of a screening assay
for assessing the effect of paclitaxel on smooth muscle cell
migration.
[0043] FIG. 14 is a graph showing the results of a screening assay
for assessing the effect of geldanamycin on IL-1.beta. production
by THP-1 macrophages.
[0044] FIG. 15 is a graph showing the results of a screening assay
for assessing the effect of geldanamycin on IL-8 production by
THP-1 macrophages.
[0045] FIG. 16 is a graph showing the results of a screening assay
for assessing the effect of geldanamycin on MCP-1 production by
THP-1 macrophages.
[0046] FIG. 17 is graph showing the results of a screening assay
for assessing the effect of paclitaxel on proliferation of smooth
muscle cells.
[0047] FIG. 18 is graph showing the results of a screening assay
for assessing the effect of paclitaxel for proliferation of the
murine RAW 264.7 macrophage cell line.
[0048] FIG. 19 is a bar graph showing the area of granulation
tissue in carotid arteries exposed to silk coated perivascular
polyurethane (PU) films relative to arteries exposed to uncoated PU
films.
[0049] FIG. 20 is a bar graph showing the area of granulation
tissue in carotid arteries exposed to silk suture coated
perivascular PU films relative to arteries exposed to uncoated PU
films.
[0050] FIG. 21 is a bar graph showing the area of granulation
tissue in carotid arteries exposed to natural and purified silk
powder and wrapped with perivascular PU film relative to a control
group in which arteries are wrapped with perivascular PU film
only.
[0051] FIG. 22 is a bar graph showing the area of granulation
tissue (at 1 month and 3 months) in carotid arteries sprinkled with
talcum powder and wrapped with perivascular PU film relative to a
control group in which arteries are wrapped with perivascular PU
film only.
DETAILED DESCRIPTION OF THE INVENTION
DEFINITIONS
[0052] Prior to setting forth the invention, it may be helpful to
an understanding thereof to first set forth definitions of certain
terms that is used hereinafter.
[0053] "Medical device", "implant", "medical device or implant",
"implant/device", "the device", and the like are used synonymously
to refer to any object that is designed to be placed partially or
wholly within a patient's body for one or more therapeutic or
prophylactic purposes such as for restoring physiological function,
alleviating symptoms associated with disease, delivering
therapeutic agents, and/or repairing or replacing or augmenting
etc. damaged or diseased organs and tissues. While medical devices
are normally composed of biologically compatible synthetic
materials (e.g., medical-grade stainless steel, titanium and other
metals; exogenous polymers, such as polyurethane, silicon, PLA,
PLGA), other materials may also be used in the construction of the
medical device or implant. Specific medical devices and implants
that are particularly useful for the practice of this invention
include devices and implants that are used to provide electrical
stimulation to the central and peripheral nervous system (including
the autonomic system), cardiac muscle tissue (including myocardial
conduction pathways), smooth muscle tissue and skeletal muscle
tissue.
[0054] "Electrical device" refers to a medical device having
electrical components that can be placed in contact with tissue in
an animal host and can provide electrical excitation to nervous or
muscular tissue. Electrical devices can generate electrical
impulses and may be used to treat many bodily dysfunctions and
disorders by blocking, masking, or stimulating electrical signals
within the body. Electrical medical devices of particular utility
in the present invention include, but are not restricted to,
devices used in the treatment of cardiac rhythm abnormalities, pain
relief, epilepsy, Parkinson's Disease, movement disorders, obesity,
depression, anxiety and hearing loss.
[0055] "Neurostimulator" or "Neurostimulation Device" refers to an
electrical device for electrical excitation of the central,
autonomic, or peripheral nervous system. The neurostimulator sends
electrical impulses to an organ or tissue. The neurostimulator may
include electrical leads as part of the electrical stimulation
system. Neurostimulation may be used to block, mask, or stimulate
electrical signals in the body to treat dysfunctions, including,
without limitation, pain, seizures, anxiety disorders, depression,
ulcers, deep vein thrombosis, muscular atrophy, obesity, joint
stiffness, muscle spasms, osteoporosis, scoliosis, spinal disc
degeneration, spinal cord injury, deafness, urinary dysfunction and
gastroparesis. Neurostimulation may be delivered to many different
parts of the nervous system, including, spinal cord, brain, vagus
nerve, sacral nerve, gastric nerve, auditory nerves, as well as
organs, bone, muscles and tissues. As such, neurostimulators are
developed to conform to the different anatomical structures and
nervous system characteristics.
[0056] "Cardiac Stimulation Device" or "Cardiac Rhythm Management
Device" or "Cardiac Pacemaker" or "Implantable Cardiac
Defibrillator (ICD)" all refer to an electrical device for
electrical excitation of cardiac muscle tissue (including the
specialized cardiac muscle cells that make up the conductive
pathways of the heart). The cardiac pacemaker sends electrical
impulses to the muscle (myocardium) or conduction tissue of the
heart. The pacemaker may include electrical leads as part of the
electrical stimulation system. Cardiac pacemakers may be used to
block, mask, or stimulate electrical signals in the heart to treat
dysfunctions, including, without limitation, atrial rhythm
abnormalities, conduction abnormalities and ventricular rhythm
abnormalities.
[0057] "Electrical lead" refers to an electrical device that is
used as a conductor to carry electrical signals from the generator
to the tissues. Typically, electrical leads are composed of a
connector assembly, a lead body (i.e., conductor) and an electrode.
The electrical lead may be a wire or other material that transmits
electrical impulses from a generator (e.g., pacemaker,
defibrillator, or other neurostimulator). Electrical leads may be
unipolar, in which they are adapted to provide effective therapy
with only one electrode. Multi-polar leads are also available,
including bipolar, tripolar and quadripolar leads.
[0058] "Fibrosis" or "Scarring" refers to the formation of fibrous
(scar) tissue (or in the case of injury in the CNS--the formation
of glial tissue, or "gliosis", by astrocytes) in response to injury
or medical intervention. Therapeutic agents which inhibit fibrosis
or scarring can do so through one or more mechanisms including:
inhibiting angiogenesis, inhibiting migration or proliferation of
connective tissue cells (such as fibroblasts, smooth muscle cells,
vascular smooth muscle cells), reducing ECM production, and/or
inhibiting tissue remodeling. Therapeutic agents which inhibit
gliosis can do so through one or more mechanisms including:
inhibiting migration of glial cells, inhibition of hypertrophy of
glial cells, and/or inhibiting proliferation of glial cells. In
addition, numerous therapeutic agents described in this invention
may have the additional benefit of also reducing tissue
regeneration (the replacement of injured cells by cells of the same
type) when appropriate.
[0059] "Inhibit fibrosis", "reduce fibrosis", "inhibit gliosis",
"reduce gliosis" and the like are used synonymously to refer to the
action of agents or compositions which result in a statistically
significant decrease in the formation of fibrous or glial tissue
that may be expected to occur in the absence of the agent or
composition.
[0060] "Inhibitor" refers to an agent which prevents a biological
process from occurring or slows the rate or degree of occurrence of
a biological process. The process may be a general one such as
scarring or refer to a specific biological action such as, for
example, a molecular process resulting in release of a
cytokine.
[0061] "Antagonist" refers to an agent which prevents a biological
process from occurring or slows the rate or degree of occurrence of
a biological process. While the process may be a general one,
typically this refers to a drug mechanism where the drug competes
with a molecule for an active molecular site or prevents a molecule
from interacting with the molecular site. In these situations, the
effect is that the molecular process is inhibited.
[0062] "Agonist" refers to an agent which stimulates a biological
process or rate or degree of occurrence of a biological process.
The process may be a general one such as scarring or refer to a
specific biological action such as, for example, a molecular
process resulting in release of a cytokine.
[0063] "Anti-microtubule agents" should be understood to include
any protein, peptide, chemical, or other molecule which impairs the
function of microtubules, for example, through the prevention or
stabilization of polymerization. Compounds that stabilize
polymerization of microtubules are referred to herein as
"microtubule stabilizing agents." A wide variety of methods may be
utilized to determine the anti-microtubule activity of a particular
compound, including for example, assays described by Smith et al.
(Cancer Lett. 79(2):213-219, 1994) and Mooberry et al., (Cancer
Lett. 96(2):261-266, 1995).
[0064] "Host", "Person", "Subject", "Patient" and the like are used
synonymously to refer to the living being (human or animal) into
which a device of the present invention is implanted.
[0065] "Implanted" refers to having completely or partially placed
a device within a host. A device is partially implanted when some
of the device reaches, or extends to the outside of, a host.
[0066] "Release of an agent" refers to a statistically significant
presence of the agent, or a subcomponent thereof, which has
disassociated from the implant/device and/or remains active on the
surface of (or within) the device/implant.
[0067] "Biodegradable" refers to materials for which the
degradation process is at least partially mediated by, and/or
performed in, a biological system. "Degradation" refers to a chain
scission process by which a polymer chain is cleaved into oligomers
and monomers. Chain scission may occur through various mechanisms,
including, for example, by chemical reaction (e.g., hydrolysis) or
by a thermal or photolytic process. Polymer degradation may be
characterized, for example, using gel permeation chromatography
(GPC), which monitors the polymer molecular mass changes during
erosion and drug release. Biodegradable also refers to materials
may be degraded by an erosion process mediated by, and/or performed
in, a biological system. "Erosion" refers to a process in which
material is lost from the bulk. In the case of a polymeric system,
the material may be a monomer, an oligomer, a part of a polymer
backbone, or a part of the polymer bulk. Erosion includes (i)
surface erosion, in which erosion affects only the surface and not
the inner parts of a matrix; and (ii) bulk erosion, in which the
entire system is rapidly hydrated and polymer chains are cleaved
throughout the matrix. Depending on the type of polymer, erosion
generally occurs by one of three basic mechanisms (see, e.g.,
Heller, J., CRC Critical Review in Therapeutic Drug Carrier Systems
(1984), 1(1), 39-90); Siepmann, J. et al., Adv. Drug Del. Rev.
(2001), 48, 229-247): (1) water-soluble polymers that have been
insolubilized by covalent cross-links and that solubilize as the
cross-links or the backbone undergo a hydrolytic cleavage; (2)
polymers that are initially water insoluble are solubilized by
hydrolysis, ionization, or pronation of a pendant group; and (3)
hydrophobic polymers are converted to small water-soluble molecules
by backbone cleavage. Techniques for characterizing erosion include
thermal analysis (e.g., DSC), X-ray diffraction, scanning electron
microscopy (SEM), electron paramagnetic resonance spectroscopy
(EPR), NMR imaging, and recording mass loss during an erosion
experiment. For microspheres, photon correlation spectroscopy (PCS)
and other particles size measurement techniques may be applied to
monitor the size evolution of erodible devices versus time.
[0068] As used herein, "analogue" refers to a chemical compound
that is structurally similar to a parent compound, but differs
slightly in composition (e.g., one atom or functional group is
different, added, or removed). The analogue may or may not have
different chemical or physical properties than the original
compound and may or may not have improved biological and/or
chemical activity. For example, the analogue may be more
hydrophilic or it may have altered reactivity as compared to the
parent compound. The analogue may mimic the chemical and/or
biologically activity of the parent compound (i.e., it may have
similar or identical activity), or, in some cases, may have
increased or decreased activity. The analogue may be a naturally or
non-naturally occurring (e.g., recombinant) variant of the original
compound. An example of an analogue is a mutein (i.e., a protein
analogue in which at least one amino acid is deleted, added, or
substituted with another amino acid). Other types of analogues
include isomers (enantiomers, diasteromers, and the like) and other
types of chiral variants of a compound, as well as structural
isomers. The analogue may be a branched or cyclic variant of a
linear compound. For example, a linear compound may have an
analogue that is branched or otherwise substituted to impart
certain desirable properties (e.g., improve hydrophilicity or
bioavailability).
[0069] As used herein, "derivative" refers to a chemically or
biologically modified version of a chemical compound that is
structurally similar to a parent compound and (actually or
theoretically) derivable from that parent compound. A "derivative"
differs from an "analogue" in that a parent compound may be the
starting material to generate a "derivative," whereas the parent
compound may not necessarily be used as the starting material to
generate an "analogue." A derivative may or may not have different
chemical or physical properties of the parent compound. For
example, the derivative may be more hydrophilic or it may have
altered reactivity as compared to the parent compound.
Derivatization (i.e., modification) may involve substitution of one
or more moieties within the molecule (e.g., a change in functional
group). For example, a hydrogen may be substituted with a halogen,
such as fluorine or chlorine, or a hydroxyl group (--OH) may be
replaced with a carboxylic acid moiety (--COOH). The term
"derivative" also includes conjugates, and prodrugs of a parent
compound (i.e., chemically modified derivatives which can be
converted into the original compound under physiological
conditions). For example, the prodrug may be an inactive form of an
active agent. Under physiological conditions, the prodrug may be
converted into the active form of the compound. Prodrugs may be
formed, for example, by replacing one or two hydrogen atoms on
nitrogen atoms by an acyl group (acyl prodrugs) or a carbamate
group (carbamate prodrugs). More detailed information relating to
prodrugs is found, for example, in Fleisher et al., Advanced Drug
Delivery Reviews 19 (1996)115; Design of Prodrugs, H. Bundgaard
(ed.), Elsevier, 1985; or H. Bundgaard, Drugs of the Future 16
(1991) 443. The term "derivative" is also used to describe all
solvates, for example hydrates or adducts (e.g., adducts with
alcohols), active metabolites, and salts of the parent compound.
The type of salt that may be prepared depends on the nature of the
moieties within the compound. For example, acidic groups, for
example carboxylic acid groups, can form, for example, alkali metal
salts or alkaline earth metal salts (e.g., sodium salts, potassium
salts, magnesium salts and calcium salts, and also salts with
physiologically tolerable quaternary ammonium ions and acid
addition salts with ammonia and physiologically tolerable organic
amines such as, for example, triethylamine, ethanolamine or
tris-(2-hydroxyethyl)amine). Basic groups can form acid addition
salts, for example with inorganic acids such as hydrochloric acid,
sulfuric acid or phosphoric acid, or with organic carboxylic acids
and sulfonic acids such as acetic acid, citric acid, benzoic acid,
maleic acid, fumaric acid, tartaric acid, methanesulfonic acid or
p-toluenesulfonic acid. Compounds which simultaneously contain a
basic group and an acidic group, for example a carboxyl group in
addition to basic nitrogen atoms, can be present as zwitterions.
Salts can be obtained by customary methods known to those skilled
in the art, for example by combining a compound with an inorganic
or organic acid or base in a solvent or diluent, or from other
salts by cation exchange or anion exchange.
[0070] Any concentration ranges, percentage range, or ratio range
recited herein are to be understood to include concentrations,
percentages or ratios of any integer within that range and
fractions thereof, such as one tenth and one hundredth of an
integer, unless otherwise indicated. Also, any number range recited
herein relating to any physical feature, such as polymer subunits,
size or thickness, are to be understood to include any integer
within the recited range, unless otherwise indicated. It should be
understood that the terms "a" and "an" as used above and elsewhere
herein refer to "one or more" of the enumerated components. For
example, "a" polymer refers to one polymer or a mixture comprising
two or more polymers. As used herein, the term "about" means
.+-.15%.
[0071] As discussed above, the present invention provides
compositions, methods and devices relating to medical devices and
implants, which greatly increase their ability to inhibit the
formation of reactive scar (or glial) tissue on, or around, the
surface of the device or implant. Described in more detail below
are methods for constructing medical devices or implants,
compositions and methods for generating medical devices and
implants which inhibit fibrosis, and methods for utilizing such
medical devices and implants.
[0072] A. Clinical Applications of Electrical Medical Devices and
Implants Which Contain a Fibrosis-inhibiting Aqent
[0073] Medical devices having electrical components, such as
electrical pacing or stimulating devices, can be implanted in the
body to provide electrical conduction to the central and peripheral
nervous system (including the autonomic system), cardiac muscle
tissue (including myocardial conduction pathways), smooth muscle
tissue and skeletal muscle tissue. These electrical impulses are
used to treat many bodily dysfunctions and disorders by blocking,
masking, stimulating, or replacing electrical signals within the
body. Examples include pacemaker leads used to maintain the normal
rhythmic beating of the heart; defibrillator leads used to
"re-start" the heart when it stops beating; peripheral nerve
stimulating devices to treat chronic pain; deep brain electrical
stimulation to treat conditions such as tremor, Parkinson's
disease, movement disorders, epilepsy, depression and psychiatric
disorders; and vagal nerve stimulation to treat epilepsy,
depression, anxiety, obesity, migraine and Alzheimer's Disease.
[0074] The clinical function of an electrical device such as a
cardiac pacemaker lead, neurostimulation lead, or other electrical
lead depends upon the device being able to effectively maintain
intimate anatomical contact with the target tissue (typically
electrically excitable cells such as muscle or nerve) such that
electrical conduction from the device to the tissue can occur.
Unfortunately, in many instances when these devices are implanted
in the body, they are subject to a "foreign body" response from the
surrounding host tissues. The body recognizes the implanted device
as foreign, which triggers an inflammatory response followed by
encapsulation of the implant with fibrous connective tissue (or
glial tissue--called "gliosis"--when it occurs within the central
nervous system). Scarring (i.e., fibrosis or gliosis) can also
result from trauma to the anatomical structures and tissue
surrounding the implant during the implantation of the device.
Lastly, fibrous encapsulation of the device can occur even after a
successful implantation if the device is manipulated (some patients
continuously "fiddle" with a subcutaneous implant) or irritated by
the daily activities of the patient. When scarring occurs around
the implanted device, the electrical characteristics of the
electrode-tissue interface degrade, and the device may fail to
function properly. For example, it may require additional
electrical current from the lead to overcome the extra resistance
imposed by the intervening scar (or glial) tissue. This can shorten
the battery life of an implant (making more frequent removal and
re-implantation necessary), prevent electrical conduction
altogether (rendering the implant clinically ineffective) and/or
cause damage to the target tissue. Additionally, the surrounding
tissue may be inadvertently damaged from the inflammatory foreign
body response, which can result in loss of function or tissue
necrosis.
[0075] The present invention addresses these problems. Exemplary
electrical devices are described next.
[0076] 1) Neurostimulation Devices
[0077] In one aspect, the electrical device may be a
neurostimulation device where a pulse generator delivers an
electrical impulse to a nervous tissue (e.g., CNS, peripheral
nerves, autonomic nerves) in order to regulate its activity. There
are numerous neurostimulator devices where the occurrence of a
fibrotic reaction may adversely affect the functioning of the
device or the biological problem for which the device was implanted
or used. Typically, fibrotic encapsulation of the electrical lead
(or the growth of fibrous tissue between the lead and the target
nerve tissue) slows, impairs, or interrupts electrical transmission
of the impulse from the device to the tissue. This can cause the
device to function suboptimally or not at all, or can cause
excessive drain on battery life because increased energy is
required to overcome the electrical resistance imposed by the
intervening scar (or glial) tissue.
[0078] Neurostimulation devices are used as alternative or
adjunctive therapy for chronic, neurodegenerative diseases, which
are typically treated with drug therapy, invasive therapy, or
behavioral/lifestyle changes. Neurostimulation may be used to
block, mask, or stimulate electrical signals in the body to treat
dysfunctions, including, without limitation, pain, seizures,
anxiety disorders, depression, ulcers, deep vein thrombosis,
muscular atrophy, obesity, joint stiffness, muscle spasms,
osteoporosis, scoliosis, spinal disc degeneration, spinal cord
injury, deafness, urinary dysfunction and gastroparesis.
Neurostimulation may be delivered to many different parts of the
nervous system, including, spinal cord, brain, vagus nerve, sacral
nerve, gastric nerve, auditory nerves, as well as organs, bone,
muscles and tissues. As such, neurostimulators are developed to
conform to the different anatomical structures and nervous system
characteristics. Representative examples of neurologic and
neurosurgical implants and devices that can be coated with, or
otherwise constructed to contain and/or release the therapeutic
agents provided herein, include, e.g., nerve stimulator devices to
provide pain relief, devices for continuous subarachnoid infusions,
implantable electrodes, stimulation electrodes, implantable pulse
generators, electrical leads, stimulation catheter leads,
neurostimulation systems, electrical stimulators, cochlear
implants, auditory stimulators and microstimulators.
[0079] Neurostimulation devices may also be classified based on
their source of power, which includes: battery powered,
radio-frequency (RF) powered, or a combination of both types. For
battery powered neurostimulators, an implanted, non-rechargeable
battery is used for power. The battery and leads are all surgically
implanted and thus the neurostimulation device is completely
internal. The settings of the totally implanted neurostimulator are
controlled by the patient through an external magnet. The lifetime
of the implant is generally limited by the duration of battery life
and ranges from two to four years depending upon usage and power
requirements. For RF-powered neurostimulation devices, the
radio-frequency is transmitted from an externally worn source to an
implanted passive receiver. Since the power source is readily
rechargeable or replaceable, the radio-frequency system enables
greater power resources and thus, multiple leads may be used in
these systems. Specific examples include a neurostimulator that has
a battery power source contained within to supply power over an
eight hour period in which power may be replenished by an external
radio frequency coupled device (See e.g., U.S. Pat. No. 5,807,397)
or a microstimulator which is controlled by an external transmitter
using data signals and powered by radio frequency (See e.g., U.S.
Pat. No. 6,061,596).
[0080] Examples of commercially available neurostimulation products
include a radio-frequency powered neurostimulator comprised of the
3272 MATTRIX Receiver, 3210 MATTRIX Transmitter and 3487A
PISCES-QUAD Quadripolar Leads made by Medtronic, Inc. (Minneapolis,
Minn.). Medtronic also sells a battery-powered ITREL 3
Neurostimulator and SYNERGY Neurostimulator, the INTERSIM Therapy
for sacral nerve stimulation for urinary control, and leads such as
the 3998 SPECIFY Lead and 3587A RESUME II Lead.
[0081] Another example of a neurostimulation device is a gastric
pacemaker, in which multiple electrodes are positioned along the GI
tract to deliver a phased electrical stimulation to pace
peristaltic movement of the material through the GI tract. See,
e.g., U.S. Pat. No. 5,690,691. A representative example of a
gastric stimulation device is the ENTERRA Gastric Electrical
Stimulation (GES) from Medtronic, Inc. (Minneapolis, Minn.).
[0082] The neurostimulation device, particularly the lead(s), must
be positioned in a very precise manner to ensure that stimulation
is delivered to the correct anatomical location in the nervous
system. All, or parts, of a neurostimulation device can migrate
following surgery, or excessive scar (or glial) tissue growth can
occur around the implant, which can lead to a reduction in the
performance of these devices (as described previously).
Neurostimulator devices that release a therapeutic agent for
reducing scarring (or gliosis) at the electrode-tissue interface
can be used to increase the efficacy and/or the duration of
activity (particularly for fully-implanted, battery-powered
devices) of the implant. Accordingly, the present invention
provides neurostimulator leads that are coated with an
anti-scarring agent or a composition that includes an anti-scarring
(or anti-gliosis) agent.
[0083] For greater clarity, several specific neurostimulation
devices and treatments will be described in greater detail
including:
[0084] a) Neurostimulation for the Treatment of Chronic Pain
[0085] Chronic pain is one of the most important clinical problems
in all of medicine. For example, it is estimated that over 5
million people in the United States are disabled by back pain. The
economic cost of chronic back pain is enormous, resulting in over
100 million lost work days annually at an estimated cost of $50-100
billion. It has been reported that approximately 40 million
Americans are afflicted with recurrent headaches and that the cost
of medications for this condition exceeds $4 billion a year. A
further 8 million people in the U.S. report that they experience
chronic neck or facial pain and spend an estimated $2 billion a
year for treatment. The cost of managing pain for oncology patients
is thought to approach $12 billion. Chronic pain disables more
people than cancer or heart disease and costs the American public
more than both cancer and heart disease combined. In addition to
the physical consequences, chronic pain has numerous other costs
including loss of employment, marital discord, depression and
prescription drug addiction. It goes without saying, therefore,
that reducing the morbidity and costs associated with persistent
pain remains a significant challenge for the healthcare system.
[0086] Intractable severe pain resulting from injury, illness,
scoliosis, spinal disc degeneration, spinal cord injury,
malignancy, arachnoiditis, chronic disease, pain syndromes (e.g.,
failed back syndrome, complex regional pain syndrome) and other
causes is a debilitating and common medical problem. In many
patients, the continued use of analgesics, particularly drugs like
narcotics, are not a viable solution due to tolerance, loss of
effectiveness, and addiction potential. In an effort to combat
this, neurostimulation devices have been developed to treat severe
intractable pain that is resistant to other traditional treatment
modalities such as drug therapy, invasive therapy (surgery), or
behavioral/lifestyle changes.
[0087] In principle, neurostimulation works by delivering low
voltage electrical stimulation to the spinal cord or a particular
peripheral nerve in order to block the sensation of pain. The Gate
Control Theory of Pain (Ronald Meizack and Patrick Wall)
hypothesizes that there is a "gate" in the dorsal horn of the
spinal cord that controls the flow of pain signals from the
peripheral receptors to the brain. It is speculated that the body
can inhibit the pain signals ("close the gate") by activating other
(non-pain) fibers in the region of the dorsal horn.
Neurostimulation devices are implanted in the epidural space of the
spinal cord to stimulate non-noxious nerve fibers in the dorsal
horn and mask the sensation of pain. As a result the patient
typically experiences a tingling sensation (known as paresthesia)
instead of pain. With neurostimulation, the majority of patients
will report improved pain relief (50% reduction), increased
activity levels and a reduction in the use of narcotics.
[0088] Pain management neurostimulation systems consist of a power
source that generates the electrical stimulation, leads (typically
1 or 2) that deliver electrical stimulation to the spinal cord or
targeted peripheral nerve, and an electrical connection that
connects the power source to the leads. Neurostimulation systems
can be battery powered, radio-frequency powered, or a combination
of both. In general, there are two types of neurostimulation
devices: those that are surgically implanted and are completely
internal (i.e., the battery and leads are implanted), and those
with internal (leads and radio-frequency receiver) and external
(power source and antenna) components. For internal,
battery-powered neurostimulators, an implanted, non-rechargeable
battery and the leads are all surgically implanted. The settings of
the totally implanted neurostimulator may be controlled by the host
by using an external magnet and the implant has a lifespan of two
to four years. For radio-frequency powered neurostimulators, the
radio-frequency is transmitted from an externally worn source to an
implanted passive receiver. The radio-frequency system enables
greater power resources and thus, multiple leads may be used.
[0089] There are numerous neurostimulation devices that can be used
for spinal cord stimulation in the management of pain control,
postural positioning and other disorders. Examples of specific
neurostimulation devices include those composed of a sensor that
detects the position of the spine and a stimulator that
automatically emits a series of pulses which decrease in amplitude
when back is in a supine position. See e.g., U.S. Pat. Nos.
5,031,618 and 5,342,409. The neurostimulator may be composed of
electrodes and a control circuit which generates pulses and rest
periods based on intervals corresponding to the body's activity and
regeneration period as a treatment for pain. See e.g., U.S. Pat.
No. 5,354,320. The neurostimulator, which may be implanted within
the epidural space parallel to the axis of the spinal cord, may
transmit data to a receiver which generates a spinal cord
stimulation pulse that may be delivered via a coupled,
multi-electrode. See e.g., U.S. Pat. No. 6,609,031. The
neurostimulator may be a stimulation catheter lead with a sheath
and at least three electrodes that provide stimulation to neural
tissue. See e.g., U.S. Pat. No. 6,510,347. The neurostimulator may
be a self-centering epidual spinal cord lead with a pivoting region
to stabilize the lead which inflates when injected with a hardening
agent. See e.g., U.S. Pat. No. 6,308,103. Other neurostimulators
used to induce electrical activity in the spinal cord are described
in, e.g., U.S. Pat. Nos. 6,546,293; 6,236,892; 4,044,774 and
3,724,467.
[0090] Commercially available neurostimulation devices for the
management of chronic pain include the SYNERGY, INTREL, X-TREL and
MATTRIX neurostimulation systems from Medtronic, Inc. The
percutaneous leads in this system can be quadripolar (4
electrodes), such as the PISCES-QUAD, PISCES-QUAD PLUS and the
PISCES-QUAD Compact, or octapolar (8 electrodes) such as the OCTAD
lead. The surgical leads themselves are quadripolar, such as the
SPECIFY Lead, the RESUME II Lead, the RESUME TL Lead and the
ON-POINT PNS Lead, to create multiple stimulation combinations and
a broad area of paresthesia. These neurostimulation systems and
associated leads may be described, for example, in U.S. Pat. Nos.
6,671,544; 6,654,642; 6,360,750; 6,353,762; 6,058,331; 5,342,409;
5,031,618 and 4,044,774. Neurostimulating leads such as these may
benefit from release of a therapeutic agent able to reducing
scarring at the electrode-tissue interface to increase the
efficiency of impulse transmission and increase the duration that
the leads function clinically. In one aspect, the device includes
spinal cord stimulating devices and/or leads that are coated with
an anti-scarring (or anti-gliosis) agent or a composition that
includes an anti-scarring (or anti-gliosis) agent. As an
alternative to this, or in addition to this, a composition that
includes an anti-scarring agent can be infiltrated into the
epidural space where the lead will be implanted. Other commercially
available systems that may useful for the practice of this
invention as described above include the rechargeable PRECISION
Spinal Cord Stimulation System (Advanced Bionics Corporation,
Sylmar, Calif.; which is a Boston Scientific Company) which can
drive up to 16 electrodes (see e.g., U.S. Pat. Nos. 6,735,474;
6,735,475; 6,659,968; 6,622,048; 6,516,227 and 6,052,624). The
GENESIS XP Spinal Cord Stimulator available from Advanced
Neuromodulation Systems, Inc. (Plano, Tex.; see e.g., U.S. Pat.
Nos. 6,748,276; 6,609,031 and 5,938,690) as well as the Vagus Nerve
Stimulation (VNS) Therapy System available from Cyberonics, Inc.
(Houston, Tex.; see e.g., U.S. Pat. Nos. 6,721,603 and 5,330,515)
may also benefit from the application of anti-fibrosis (or
anti-gliosis) agents as described in this invention.
[0091] Regardless of the specific design features, for
neurostimulation to be effective in pain relief, the leads must be
accurately positioned adjacent to the portion of the spinal cord or
the targeted peripheral nerve that is to be electrically
stimulated. Neurostimulators can migrate following surgery or
excessive tissue growth or extracellular matrix deposition can
occur around neurostimulators, which can lead to a reduction in the
functioning of these devices. Neurostimulator devices that release
therapeutic agent for reducing scarring at the electrode-tissue
interface can be used to increase the duration that these devices
clinically function. In one aspect, the device includes
neurostimulator devices and/or leads that are coated with an
anti-scarring (or anti-gliosis) agent or a composition that
includes an anti-scarring (or anti-gliosis) agent. As an
alternative to this, or in addition to this, a composition that
includes an anti-scarring (anti-gliosis) agent can be infiltrated
into the tissue surrounding the implanted portion (particularly the
leads) of the pain management neurostimulation device.
[0092] b) Neurostimulation for the Treatment of Parkinson's
Disease
[0093] Neurostimulation devices implanted into the brain are used
to control the symptoms associated with Parkinson's disease or
essential tremor. Typically, these are dual chambered stimulator
devices (similar to cardiac pacemakers) that deliver bilateral
stimulation to parts of the brain that control motor function.
Electrical stimulation is used to relieve muscular symptoms due to
Parkinson's disease itself (tremor, rigidity, bradykinesia,
akinesia) or symptoms that arise as a result of side effects of the
medications used to treat the disease (dyskinesias). Two
stimulating electrodes are implanted in the brain (usually
bilaterally in the subthalamic nucleus or the globus pallidus
intema) for the treatment of levodopa-responsive Parkinson's and
one is implanted (in the ventral intermediate nucleus of the
thalamus) for the treatment of tremor. The electrodes are implanted
in the brain by a functional stereotactic neurosurgeon using a
stereotactic head frame and MRI or CT guidance. The electrodes are
connected via extensions (which run under the skin of the scalp and
neck) to a neurostimulatory (pulse generating) device implanted
under the skin near the clavicle. A neurologist can then optimize
symptom control by adjusting stimulation parameters using a
noninvasive control device that communicates with the
neurostimulator via telemetry. The patient is also able to turn the
system on and off using a magnet and control the device (within
limits set by the neurologist) settings using a controller device.
This form of deep brain stimulation has also been investigated for
the treatment pain, epilepsy, psychiatric conditions
(obsessive-compulsive disorder) and dystonia.
[0094] Several devices have been described for such applications
including, for example, a neurostimulator and an implantable
electrode that has a flexible, non-conducting covering material,
which is used for tissue monitoring and stimulation of the cortical
tissue of the brain as well as other tissue. See e.g., U.S. Pat.
No. 6,024,702. The neurostimulator (pulse generator) may be an
intracranially implanted electrical control module and a plurality
of electrodes which stimulate the brain tissue with an electrical
signal at a defined frequency. See e.g., U.S. Pat. No. 6,591,138.
The neurostimulator may be a system composed of at least two
electrodes adapted to the cranium and a control module adapted to
be implanted beneath the scalp for transmitting output electrical
signals and also external equipment for providing two-way
communication. See e.g., U.S. Pat. No. 6,016,449. The
neurostimulator may be an implantable assembly composed of a sensor
and two electrodes, which are used to modify the electrical
activity in the brain. See e.g., U.S. Pat. No. 6,466,822.
[0095] A commercial example of a device used to treat Parkinson's
disease and essential tremor includes the ACTIVA System by
Medtronic, Inc. (see, for example, U.S. Pat. Nos. 6,671,544 and
6,654,642). This system consists of the KINETRA Dual Chamber
neurostimulator, the SOLETRA neurostimulator or the INTREL
neurostimulator, connected to an extension (an insulated wire),
that is further connected to a DBS lead. The DBS lead consists of
four thin, insulated, coiled wires bundled with polyurethane. Each
of the four wires ends in a 1.5 mm long electrode. Although all or
parts of the DBS lead may be suitable for coating with a
fibrosis/gliosis-inhibiting composition, a preferred embodiment
involves delivering the therapeutic agent from the surface of the
four electrodes. As an alternative to this, or in addition to this,
a composition that includes an anti-gliosis agent can be
infiltrated into the brain tissue surrounding the leads.
[0096] c) Vagal Nerve Stimulation for the Treatment of Epilepsy
[0097] Neurostimulation devices are also used for vagal nerve
stimulation in the management of pharmacoresistant epilepsy (i.e.,
epilepsy that is uncontrolled despite appropriate medical treatment
with ant-epileptic drugs). Approximately 30% of epileptic patients
continue to have seizures despite of multiple attempts at
controlling the disease with drug therapy or are unable to tolerate
the side effects of their medications. It is estimated that
approximately 2.5 million patients in the United States suffer from
treatment-resistant epilepsy and may benefit from vagal nerve
stimulation therapy. As such, inadequate seizure control remains a
significant medical problem with many patients suffering from
diminished self esteem, poor academic achievement and a restricted
lifestyle as a result of their illness.
[0098] The vagus nerve (also called the 10.sup.th cranial nerve)
contains primarily afferent sensory fibres that carry information
from the neck, thorax and abdomen to the nucleus tractus soltarius
of the brainstem and on to multiple noradrenergic and serotonergic
neuromodulatory systems in the brain and spinal cord. Vagal nerve
stimulation (VNS) has been shown to induce progressive EEG changes,
alter bilateral cerebral blood flow, and change blood flow to the
thalamus. Although the exact mechanism of seizure control is not
known, VNS has been demonstrated clinically to terminate seizures
after seizure onset, reduce the severity and frequency of seizures,
prevent seizures when used prophylactically over time, improve
quality of life, and reduce the dosage, number and side effects of
anti-epileptic medications (resulting in improved alertness, mood,
memory).
[0099] In VNS, a bipolar electrical lead is surgically implanted
such that it transmits electrical stimulation from the pulse
generator to the left vagus nerve in the neck. The pulse generator
is an implanted, lithium carbon monofluoride battery-powered device
that delivers a precise pattern of stimulation to the vagus nerve.
The pulse generator can be programmed (using a programming wand) by
the neurologist to suit an individual patient's symptoms, while the
patient can turn the device on and off through the use of an
external magnet. Chronic electrical stimulation which can be used
as a direct treatment for epilepsy is described in, for example,
U.S. Pat. No. 6,016,449, whereby, an implantable neurostimulator is
coupled to relatively permanent deep brain electrodes. The
implantable neurostimulator may be composed of an implantable
electrical lead having a furcated, or split, distal portion with
two or more separate end segments, each of which bears at least one
sensing or stimulation electrode, which may be used to treat
epilepsy and other neurological disorders. See e.g., U.S. Pat. No.
6,597,953.
[0100] A commercial example of a VNS system is the product produced
by Cyberonics, Inc. that includes the Model 300 and Model 302
leads, the Model 101 and Model 102R pulse generators, the Model 201
programming wand and Model 250 programming software, and the Model
220 magnets. These products manufactured by Cyberonics, Inc. may be
described, for example, in U.S. Pat. Nos. 5,540,730 and
5,299,569.
[0101] Regardless of the specific design features, for vagal nerve
stimulation to be effective in epilepsy, the leads must be
accurately positioned adjacent to the left vagus nerve. If
excessive scar tissue growth or extracellular matrix deposition
occurs around the VNS leads, this can reduce the efficacy of the
device. VNS devices that release a therapeutic agent able to
reducing scarring at the electrode-tissue interface can increase
the efficiency of impulse transmission and increase the duration
that these devices function clinically. In one aspect, the device
includes VNS devices and/or leads that are coated with an
anti-scarring agent or a composition that includes an anti-scarring
agent. As an alternative to this, or in addition to this, a
composition that includes an anti-scarring agent can be infiltrated
into the tissue surrounding the vagus nerve where the lead will be
implanted.
[0102] d) Vagal Nerve Stimulation for the Treatment of Other
Disorders
[0103] It was discovered during the use of VNS for the treatment of
epilepsy that some patients experienced an improvement in their
mood during therapy. As such, VNS is currently being examined for
use in the management of treatment-resistant mood disorders such as
depression and anxiety. Depression remains an enormous clinical
problem in the Western World with over 1% (25 million people in the
United States) suffering from depression that is inadequately
treated by pharmacotherapy. Vagal nerve stimulation has been
examined in the management of conditions such as anxiety (panic
disorder, obsessive-compulsive disorder, post-traumatic stress
disorder), obesity, migraine, sleep disorders, dementia,
Alzheimer's disease and other chronic or degenerative neurological
disorders. VNS has also been examined for use in the treatment of
medically significant obesity.
[0104] The implantable neurostimulator for the treatment of
neurological disorders may be composed of an implantable electrical
lead having a furcated, or split, distal portion with two or more
separate end segments, each of which bears at least one sensing or
stimulation electrode. See e.g., U.S. Pat. No. 6,597,953. The
implantable neurostimulator may be an apparatus for treating
Alzheimer's disease and dementia, particularly for neuro modulating
or stimulating left vagus nerve, composed of an implantable
lead-receiver, external stimulator, and primary coil. See e.g.,
U.S. Pat. No. 6,615,085.
[0105] Cyberonics, Inc. manufactures the commercially available VNS
system, including the Model 300 and Model 302 leads, the Model 101
and Model 102R pulse generators, the Model 201 programming wand and
Model 250 programming software, and the Model 220 magnets. These
products as well as others that are being developed by Cyberonics,
Inc. may be used to treat neurological disorders, including
depression (see e.g., U.S. Pat. No. 5,299,569), dementia (see e.g.,
U.S. Pat. No. 5,269,303), migraines (see e.g., U.S. Pat. No.
5,215,086), sleep disorders (see e.g., U.S. Pat. No. 5,335,657) and
obesity (see e.g., U.S. Pat. Nos. 6,587,719; 6,609,025; 5,263,480
and 5,188,104).
[0106] It is important to note that the fundamentals of treatment
are identical to those described above for epilepsy. The devices
employed and the principles of therapy are also similar. As was
described above for the treatment of epilepsy, if excessive scar
tissue growth or extracellular matrix deposition occurs around the
VNS leads, this can reduce the efficacy of the device. VNS devices
that release a therapeutic agent able to reducing scarring at the
electrode-tissue interface can increase the efficiency of impulse
transmission and increase the duration that these devices function
clinically for the treatment of depression, anxiety, obesity, sleep
disorders and dementia. In one aspect, the device includes VNS
devices and/or leads that are coated with an anti-scarring agent or
a composition that includes an anti-scarring agent. As an
alternative to this, or in addition to this, a composition that
includes an anti-scarring agent can be infiltrated into the tissue
surrounding the vagus nerve where the lead will be implanted.
[0107] e) Sacral Nerve Stimulation for Bladder Control Problems
[0108] Sacral nerve stimulation is used in the management of
patients with urinary control problems such as urge incontinence,
nonobstructive urinary retention, or urgency-frequency. Millions of
people suffer from bladder control problems and a significant
percentage (estimated to be in excess of 60%) is not adequately
treated by other available therapies such as medications, absorbent
pads, external collection devices, bladder augmentation or surgical
correction. This can be a debilitating medical problem that can
cause severe social anxiety and cause people to become isolated and
depressed.
[0109] Mild electrical stimulation of the sacral nerve is used to
influence the functioning of the bladder, urinary sphincter, and
the pelvic floor muscles (all structures which receive nerve supply
from the sacral nerve). An electrical lead is surgically implanted
adjacent to the sacral nerve and a neurostimulator is implanted
subcutaneously in the upper buttock or abdomen; the two are
connected by an extension. The use of tined leads allows sutureless
anchoring of the leads and minimally-invasive placement of the
leads under local anesthesia. A handheld programmer is available
for adjustment of the device by the attending physician and a
patient-controlled programmer is available to adjust the settings
and to turn the device on and off. The pulses are adjusted to
provide bladder control and relieve the patient's symptoms.
[0110] Several neurostimulation systems have been described for
sacral nerve stimulation in which electrical stimulation is
targeted towards the bladder, pelvic floor muscles, bowel and/or
sexual organs. For example, the neurostimulator may be an
electrical stimulation system composed of an electrical stimulator
and leads having insulator sheaths, which may be anchored in the
sacrum using minimally-invasive surgery. See e.g., U.S. Pat. No.
5,957,965. In another aspect, the neurostimulator may be used to
condition pelvic, sphincter or bladder muscle tissue. For example,
the neurostimulator may be intramuscular electrical stimulator
composed of a pulse generator and an elongated medical lead that is
used for electrically stimulating or sensing electrical signals
originating from muscle tissue. See e.g., U.S. Pat. No. 6,434,431.
Another neurostimulation system consists of a leadless,
tubular-shaped microstimulator that is implanted at pelvic floor
muscles or associated nerve tissue that need to be stimulated to
treat urinary incontinence. See e.g., U.S. Pat. No. 6,061,596.
[0111] A commercially available example of a neurostimulation
system to treat bladder conditions is the INTERSTIM Sacral Nerve
Stimulation System made by Medtronic, Inc. See e.g., U.S. Pat. Nos.
6,104,960; 6,055,456 and 5,957,965.
[0112] Regardless of the specific design features, for bladder
control therapy to be effective, the leads must be accurately
positioned adjacent to the sacral nerve, bladder, sphincter or
pelvic muscle (depending upon the particular system employed). If
excessive scar tissue growth or extracellular matrix deposition
occurs around the leads, efficacy can be compromised. Sacral nerve
stimulating devices (such as INTERSTIM) that release a therapeutic
agent able to reducing scarring at the electrode-tissue interface
can increase the efficiency of impulse transmission and increase
the duration that these devices function clinically. In one aspect,
the device includes sacral nerve stimulating devices and/or leads
that are coated with an anti-scarring agent or a composition that
includes an anti-scarring agent. As an alternative to this, or in
addition to this, a composition that includes an anti-scarring
agent can be infiltrated into the tissue surrounding the sacral
nerve where the lead will be implanted.
[0113] For devices designed to stimulate the bladder or pelvic
muscle tissue directly, slightly different embodiments may be
required. In this aspect, the device includes bladder or pelvic
muscle stimulating devices, leads, and/or sensors that are coated
with an anti-scarring agent or a composition that includes an
anti-scarring agent. As an alternative to this, or in addition to
this, a composition that includes an anti-scarring agent can be
directly infiltrated into the muscle tissue itself (preferably
adjacent to the lead and/or sensor that is delivering an impulse or
monitoring the activity of the muscle).
[0114] f) Gastric Nerve Stimulation for the Treatment of GI
Disorders
[0115] Neurostimulator of the gastric nerve (which supplies the
stomach and other portions of the upper GI tract) is used to
influence gastric emptying and satiety sensation in the management
of clinically significant obesity or problems associated with
impaired GI motility. Morbid obesity has reached epidemic
proportions and is thought to affect over 25 million Americans and
lead to significant health problems such as diabetes, heart attack,
stroke and death. Mild electrical stimulation of the gastric nerve
is used to influence the functioning of the upper GI tract and
stomach (all structures which receive nerve supply from the gastric
nerve). An electrical lead is surgically implanted adjacent to the
gastric nerve and a neurostimulator is implanted subcutaneously;
the two are connected by an extension. A handheld programmer is
available for adjustment of the device by the attending physician
and a patient-controlled programmer is available to adjust the
settings and to turn the device on and off. The pulses are adjusted
to provide a sensation of satiety and relieve the sensation of
hunger experienced by the patient. This can reduce the amount of
food (and hence caloric) intake and allow the patient to lose
weight successfully. Related devices include neurostimulation
devices used to stimulate gastric emptying in patients with
impaired gastric motility, a neurostimulator to promote bowel
evacuation in patients with constipation (stimulation is delivered
to the colon), and devices targeted at the bowel for patients with
other GI motility disorders.
[0116] Several such devices have been described including, for
example, a sensor that senses electrical activity in the
gastrointestinal tract which is coupled to a pulse generator that
emits and inhibits asynchronous stimulation pulse trains based on
the natural gastrointestinal electrical activity. See e.g., U.S.
Pat. No. 5,995,872. Other neurostimulation devices deliver impulses
to the colon and rectum to manage constipation and are composed of
electrical leads, electrodes and an implanted stimulation
generator. See e.g., U.S. Pat. No. 6,026,326. The neurostimulator
may be a pulse generator and electrodes that electrically stimulate
the neuromuscular tissue of the viscera to treat obesity. See e.g.,
U.S. Pat. No. 6,606,523. The neurostimulator may be a hermetically
sealed implantable pulse generator that is electrically coupled to
the gastrointestinal tract and emits two rates of electrical
stimulation to treat gastroparesis for patients with impaired
gastric emptying. See e.g., U.S. Pat. No. 6,091,992. The
neurostimulator may be composed of an electrical signal controller,
connector wire and attachment lead which generates continuous low
voltage electrical stimulation to the fundus of the stomach to
control appetite. See e.g., U.S. Pat. No. 6,564,101. Other
neurostimulators that are used to electrically stimulate the
gastrointestinal tract are described in, e.g., U.S. Pat. Nos.
6,453,199; 6,449,511 and 6,243,607.
[0117] Another example of a gastric nerve stimulation device for
use with the present invention is the TRANSCEND Implantable Gastric
Stimulator (IGS), which is currently being developed by
Transneuronix, Inc. (Mt. Arlington, N.J.). The IGS is a
programmable, bipolar pulse generator that delivers small bursts of
electrical pulses through the lead to the stomach wall to treat
obesity. See, e.g., U.S. Pat. Nos. 6,684,104 and 6,165,084.
[0118] Regardless of the specific design features, for gastric
nerve stimulation to be effective in satiety control (or
gastroparesis), the leads must be accurately positioned adjacent to
the gastric nerve. If excessive scar tissue growth or extracellular
matrix deposition occurs around the leads, efficacy can be
compromised. Gastric nerve stimulating devices (and other implanted
devices designed to influence GI motility) that release a
therapeutic agent able to reduce scarring at the electrode-tissue
interface can increase the efficiency of impulse transmission and
increase the duration that these devices function clinically. In
one aspect, the device includes gastric nerve stimulating devices
and/or leads that are coated with an anti-scarring agent or a
composition that includes an anti-scarring agent. As an alternative
to this, or in addition to this, a composition that includes an
anti-scarring agent can be infiltrated into the tissue surrounding
the gastric nerve where the lead will be implanted.
[0119] g) Cochlear Implants for the Treatment of Deafness
[0120] Neurostimulation is also used in the form of a cochlear
implant that stimulates the auditory nerve for correcting
sensorineural deafness. A sound processor captures sound from the
environment and processes it into a digital signal that is
transmitted via an antenna through the skin to the cochlear
implant. The cochlear implant, which is surgically implanted in the
cochlea adjacent to the auditory nerve, converts the digital
information into electrical signals that are communicated to the
auditory nerve via an electrode array. Effectively, the cochlear
implant serves to bypass the nonfunctional cochlear transducers and
directly depolarize afferent auditory nerve fibers. This stimulates
the nerve to send signals to the auditory center in the brain and
allows the patient to "hear" the sounds detected by the sound
processor. The treatment is used for adults with 70 dB or greater
hearing loss (and able to understand up to 50% of words in a
sentence using a hearing aid) or children 12 months or older with
90 dB hearing loss in both ears.
[0121] Although many implantations are performed without incident,
approximately 12-15% of patients experience some complications.
Histologic assessment of cochlear implants has revealed that
several forms of injury and scarring can occur. Surgical trauma can
induce cochlear fibrosis, cochlear neossification and injury to the
membranous cochlea (including loss of the sensorineural elements).
A foreign body reaction along the implant and the electrode can
produce a fibrous tissue response along the electrode array that
has been associated with implant failure. Coating the implant
and/or the electrode with an anti-scarring composition may help
reduce the incidence of failure. As an alternative, or in addition
to this, fibrosis may be reduced or prevented by the infiltration
of an anti-scarring agent into the tissue (the scala tympani) where
the electrodes contact the auditory nerve fibers.
[0122] A variety of suitable cochlear implant systems or "bionic
ears" have been described for use in association with this
invention. For example, the neurostimulator may be composed of a
plurality of transducer elements which detect vibrations and then
generates a stimulus signal to a corresponding neuron connected to
the cranial nerve. See e.g., U.S. Pat. No. 5,061,282. The
neurostimulator may be a cochlear implant having a
sound-to-electrical stimulation encoder, a body implantable
receiver-stimulator and electrodes, which emit pulses based on
received electrical signals. See e.g., U.S. Pat. No. 4,532,930. The
neurostimulator may be an intra-cochlear apparatus that is composed
of a transducer that converts an audio signal into an electrical
signal and an electrode array which electrically stimulates
predetermined locations of the auditory nerve. See e.g., U.S. Pat.
No. 4,400,590. The neurostimulator may be a stimulus generator for
applying electrical stimuli to any branch of the 8.sup.th nerve in
a generally constant rate independent of audio modulation, such
that it is perceived as active silence. See e.g., U.S. Pat. No.
6,175,767. The neurostimulator may be a subcranially implanted
electromechanical system that has an input transducer and an output
stimulator that converts a mechanical sound vibration into an
electrical signal. See e.g., U.S. Pat. No. 6,235,056. The
neurostimulator may be a cochlear implant that has a rechargeable
battery housed within the implant for storing and providing
electrical power. See e.g., U.S. Pat. No. 6,067,474. Other
neurostimulators that are used as cochlear implants are described
in, e.g., U.S. Pat. Nos. 6,358,281; 6,308,101 and 5,603,726.
[0123] Several commercially available devices are available for the
treatment of patients with significant sensorineural hearing loss
and are suitable for use with the present invention. For example,
the HIRESOLUTION Bionic Ear System (Boston Scientific Corp.,
Nattick, Mass.) consists of the HIRES AURIA Processor which
processes sound and sends a digital signal to the HIRES 90K Implant
that has been surgically implanted in the inner ear. See e.g., U.S.
Pat. Nos. 6,636,768; 6,309,410 and 6,259,951. The electrode array
that transmits the impulses generated by the HIRES 90K Implant to
the nerve may benefit from an anti-scarring coating and/or the
infiltration of an anti-scarring agent into the region around the
electrode-nerve interface. The PULSARci cochlear implant (MED-EL
GMBH, Innsbruck, Austria, see e.g., U.S. Pat. Nos. 6,556,870 and
6,231,604) and the NUCLEUS 3 cochlear implant system (Cochlear
Corp., Lane Cove, Australia, see e.g., U.S. Pat. Nos. 6,807,445;
6,788,790; 6,554,762; 6,537,200 and 6,394,947) are other commercial
examples of cochlear implants whose electrodes are suitable for
coating with an anti-scarring composition (or infiltration of an
anti-scarring agent into the region around the electrode-nerve
interface) under the present invention.
[0124] Regardless of the specific design features, for cochlear
implants to be effective in sensorineural deafness, the electrode
arrays must be accurately positioned adjacent to the afferent
auditory nerve fibers. If excessive scar tissue growth or
extracellular matrix deposition occurs around the leads, efficacy
can be compromised. Cochlear implants that release a therapeutic
agent able to reduce scarring at the electrode-tissue interface can
increase the efficiency of impulse transmission and increase the
duration that these devices function clinically. In one aspect, the
device includes cochlear implants and/or leads that are coated with
an anti-scarring agent or a composition that includes an
anti-scarring agent. As an alternative to this, or in addition to
this, a composition that includes an anti-scarring agent can be
infiltrated into the cochlear tissue surrounding the lead.
[0125] h) Electrical Stimulation to Promote Bone Growth
[0126] In another aspect, electrical stimulation can be used to
stimulate bone growth. For example, the stimulation device may be
an electrode and generator having a strain response piezoelectric
material which responds to strain by generating a charge to enhance
the anchoring of an implanted bone prosthesis to the natural bone.
See e.g., U.S. Pat. No. 6,143,035. If excessive scar tissue growth
or extracellular matrix deposition occurs around the leads,
efficacy can be compromised. Electrical bone stimulation devices
that release a therapeutic agent able to reduce scarring at the
electrode-tissue interface can increase the efficiency of impulse
transmission and increase the duration that these devices function
clinically. In one aspect, the device includes bone stimulation
devices and/or leads that are coated with an anti-scarring agent or
a composition that includes an anti-scarring agent. As an
alternative to this, or in addition to this, a composition that
includes an anti-scarring agent can be infiltrated into the bone
tissue surrounding the electrical lead.
[0127] Although numerous neurostimulation devices have been
described above, all possess similar design features and cause
similar unwanted tissue reactions following implantation. It should
be obvious to one of skill in the art that commercial
neurostimulation devices not specifically sited above as well as
next-generation and/or subsequently-developed commercial
neurostimulation products are to be anticipated and are suitable
for use under the present invention. The neurostimulation device,
particularly the lead(s), must be positioned in a very precise
manner to ensure that stimulation is delivered to the correct
anatomical location in the nervous system. All, or parts, of a
neurostimulation device can migrate following surgery, or excessive
scar (or glial) tissue growth can occur around the implant, which
can lead to a reduction in the performance of these devices.
Neurostimulator devices that release a therapeutic agent for
reducing scarring (or gliosis) at the electrode-tissue interface
can be used to increase the efficacy and/or the duration of
activity of the implant (particularly for fully-implanted,
battery-powered devices). In one aspect, the present invention
provides neurostimulator devices that include an anti-scarring (or
anti-gliosis) agent or a composition that includes an anti-scarring
(or anti-gliosis) agent. Numerous polymeric and non-polymeric
delivery systems for use in neurostimulator devices have been
described above. These compositions can further include one or more
fibrosis-inhibiting (or gliosis-inhibiting) agents such that the
overgrowth of granulation, fibrous, or gliotic tissue is inhibited
or reduced.
[0128] Methods for incorporating fibrosis-inhibiting (or
gliosis-inhibiting) compositions onto or into these neurostimulator
devices include: (a) directly affixing to the device, lead and/or
the electrode a fibrosis-inhibiting (or gliosis-inhibiting)
composition (e.g., by either a spraying process or dipping process
as described above, with or without a carrier), (b) directly
incorporating into the device, lead and/or the electrode a
fibrosis-inhibiting (or gliosis-inhibiting) composition (e.g., by
either a spraying process or dipping process as described above,
with or without a carrier (c) by coating the device, lead and/or
the electrode with a substance such as a hydrogel which may in turn
absorb the fibrosis-inhibiting (or gliosis-inhibiting) composition,
(d) by interweaving fibrosis-inhibiting (or gliosis-inhibiting)
composition coated thread (or the polymer itself formed into a
thread) into the device, lead and/or electrode structure, (e) by
inserting the device, lead and/or the electrode into a sleeve or
mesh which is comprised of, or coated with, a fibrosis-inhibiting
(or gliosis-inhibiting) composition, (f) constructing the device,
lead and/or the electrode itself (or a portion of the device and/or
the electrode) with a fibrosis-inhibiting (or gliosis-inhibiting)
composition, or (g) by covalently binding the fibrosis-inhibiting
(or gliosis-inhibiting) agent directly to the device, lead and/or
electrode surface or to a linker (small molecule or polymer) that
is coated or attached to the device surface. Each of these methods
illustrates an approach for combining an electrical device with a
fibrosis-inhibiting (also referred to herein as an anti-scarring)
or gliosis-inhibiting agent according to the present invention.
[0129] For these devices, leads and electrodes, the coating process
can be performed in such a manner as to: (a) coat the non-electrode
portions of the lead or device; (b) coat the electrode portion of
the lead; or (c) coat all or parts of the entire device with the
fibrosis-inhibiting (or gliosis-inhibiting) composition. In
addition to, or alternatively, the fibrosis-inhibiting (or
gliosis-inhibiting) agent can be mixed with the materials that are
used to make the device, lead and/or electrode such that the
fibrosis-inhibiting agent is incorporated into the final product.
In these manners, a medical device may be prepared which has a
coating, where the coating is, e.g., uniform, non-uniform,
continuous, discontinuous, or patterned.
[0130] In another aspect, a neurostimulation device may include a
plurality of reservoirs within its structure, each reservoir
configured to house and protect a therapeutic drug. The reservoirs
may be formed from divets in the device surface or micropores or
channels in the device body. In one aspect, the reservoirs are
formed from voids in the structure of the device. The reservoirs
may house a single type of drug or more than one type of drug. The
drug(s) may be formulated with a carrier (e.g., a polymeric or
non-polymeric material) that is loaded into the reservoirs. The
filled reservoir can function as a drug delivery depot which can
release drug over a period of time dependent on the release
kinetics of the drug from the carrier. In certain embodiments, the
reservoir may be loaded with a plurality of layers. Each layer may
include a different drug having a particular amount (dose) of drug,
and each layer may have a different composition to further tailor
the amount of drug that is released from the substrate. The
multi-layered carrier may further include a barrier layer that
prevents release of the drug(s). The barrier layer can be used, for
example, to control the direction that the drug elutes from the
void. Thus, the coating of the medical device may directly contact
the electrical device, or it may indirectly contact the electrical
device when there is something, e.g., a polymer layer, that is
interposed between the electrical device and the coating that
contains the fibrosis-inhibiting agent.
[0131] In addition to, or as an alternative to incorporating a
fibrosis-inhibiting (or gliosis-inhibiting) agent onto or into the
neurostimulation device, the fibrosis-inhibiting (or
gliosis-inhibiting) agent can be applied directly or indirectly to
the tissue adjacent to the neurostimulator device (preferably near
the electrode-tissue interface). This can be accomplished by
applying the fibrosis-inhibiting (or gliosis inhibiting) agent,
with or without a polymeric, non-polymeric, or secondary carrier:
(a) to the lead and/or electrode surface (e.g., as an injectable,
paste, gel or mesh) during the implantation procedure); (b) to the
surface of the tissue (e.g., as an injectable, paste, gel, in situ
forming gel or mesh) prior to, immediately prior to, or during,
implantation of the neurostimulation device, lead and/or electrode;
(c) to the surface of the lead and/or electrode and/or the tissue
surrounding the implanted lead and/or electrode (e.g., as an
injectable, paste, gel, in situ forming gel or mesh) immediately
after to the implantation of the neurostimulation device, lead
and/or electrode; (d) by topical application of the anti-fibrosis
(or gliosis) agent into the anatomical space where the
neurostimulation device, lead and/or electrode will be placed
(particularly useful for this embodiment is the use of polymeric
carriers which release the fibrosis-inhibiting agent over a period
ranging from several hours to several weeks--fluids, suspensions,
emulsions, microemulsions, microspheres, pastes, gels,
microparticulates, sprays, aerosols, solid implants and other
formulations which release the agent can be delivered into the
region where the device will be inserted); (e) via percutaneous
injection into the tissue surrounding the device, lead and/or
electrode as a solution as an infusate or as a sustained release
preparation; (f) by any combination of the aforementioned methods.
Combination therapies (i.e., combinations of therapeutic agents and
combinations with antithrombotic and/or antiplatelet agents) can
also be used.
[0132] It should be noted that certain polymeric carriers
themselves can help prevent the formation of fibrous or gliotic
tissue around the neuroimplant. These carriers (to be described
shortly) are particularly useful for the practice of this
embodiment, either alone, or in combination with a fibrosis (or
gliosis) inhibiting composition. The following polymeric carriers
can be infiltrated (as described in the previous paragraph) into
the vicinity of the electrode-tissue interface and include: (a)
sprayable collagen-containing formulations such as COSTAS IS and
crosslinked derivatized poly( ethylene glycol)-collagen
compositions (described, e.g., in U.S. Pat. Nos. 5,874,500 and
5,565,519 and referred to herein as "CT3" (both from Angiotech
Pharmaceuticals, Inc., Canada), either alone, or loaded with a
fibrosis-inhibiting (or gliosis-inhibiting) agent, applied to the
implantation site (or the implant/device surface); (b) sprayable
PEG-containing formulations such as COSEAL (Angiotech
Pharmaceuticals, Inc.), FOCALSEAL (Genzyme Corporation, Cambridge,
Mass.), SPRAYGEL or DURASEAL (both from Confluent Surgical, Inc.,
Boston, Mass.), either alone, or loaded with a fibrosis-inhibiting
(or gliosis-inhibiting) agent, applied to the implantation site (or
the implant/device surface); (c) fibrinogen-containing formulations
such as FLOSEAL or TISSEAL (both from Baxter Healthcare
Corporation, Fremont, Calif.), either alone, or loaded with a
fibrosis-inhibiting (or gliosis-inhibiting) agent, applied to the
implantation site (or the implant/device surface); (d) hyaluronic
acid-containing formulations such as RESTYLANE or PERLANE (both
from Q-Med AB, Sweden), HYLAFORM (Inamed Corporation, Santa
Barbara, Calif.), SYNVISC (Biomatrix, Inc., Ridgefield, N.J.),
SEPRAFILM or SEPRACOAT (both from Genzyme Corporation), loaded with
a fibrosis-inhibiting (or gliosis-inhibiting) agent applied to the
implantation site (or the implant/device surface); (e) polymeric
gels for surgical implantation such as REPEL (Life Medical
Sciences, Inc., Princeton, N.J.) or FLOWGEL (Baxter Healthcare
Corporation) loaded with a fibrosis-inhibiting (or
gliosis-inhibiting) agent applied to the implantation site (or the
implant/device surface); (f) orthopedic "cements" used to hold
prostheses and tissues in place loaded with a fibrosis-inhibiting
(or gliosis-inhibiting) agent applied to the implantation site (or
the implant/device surface), such as OSTEOBOND (Zimmer, Inc.,
Warsaw, Ind.), low viscosity cement (LVC); Wright Medical
Technology, Inc., Arlington, Tenn.), SIMPLEX P (Stryker
Corporation, Kalamazoo, Mich.), PALACOS (Smith & Nephew
Corporation, United Kingdom), and ENDURANCE (Johnson & Johnson,
Inc., New Brunswick, N.J.); (g) surgical adhesives containing
cyanoacrylates such as DERMABOND (Johnson & Johnson, Inc.),
INDERMIL (U.S. Surgical Company, Norwalk, Conn.), GLUSTITCH
(Blacklock Medical Products Inc., Canada), TISSUEMEND (Veterinary
Products Laboratories, Phoenix, Ariz.), VETBOND (3M Company, St.
Paul, Minn.), HISTOACRYL BLUE (Davis & Geck, St. Louis, Mo.)
and ORABASE SOOTHE-N-SEAL LIQUID PROTECTANT (Colgate-Palmolive
Company, New York, N.Y.), either alone, or loaded with a
fibrosis-inhibiting (or gliosis-inhibiting) agent, applied to the
implantation site (or the implant/device surface); (h) implants
containing hydroxyapatite [or synthetic bone material such as
calcium sulfate, VITOSS and CORTOSS (both from Orthovita, Inc.,
Malvern, Pa.) loaded with a fibrosis-inhibiting (or
gliosis-inhibiting) agent applied to the implantation site (or the
implant/device surface); (i) other biocompatible tissue fillers
loaded with a fibrosis-inhibiting (or gliosis-inhibiting) agent,
such as those made by BioCure, Inc. (Norcross, Ga.), 3M Company
(St. Paul, Minn.) and Neomend, Inc. (Sunnyvale, Calif.), applied to
the implantation site (or the implant/device surface); (j)
polysaccharide gels such as the ADCON series of gels (available
from Gliatech, Inc., Cleveland, Ohio) either alone, or loaded with
a fibrosis-inhibiting (or gliosis-inhibiting) agent, applied to the
implantation site (or the implant/device surface); and/or (k)
films, sponges or meshes such as INTERCEED (Gynecare Worldwide, a
division of Ethicon, Inc., Somerville, N.J.), VICRYL mesh (Ethicon,
Inc.), and GELFOAM (Pfizer, Inc., New York, N.Y.) loaded with a
fibrosis-inhibiting (or gliosis-inhibiting) agent applied to the
implantation site (or the implant/device surface).
[0133] A preferred polymeric matrix which can be used to help
prevent the formation of fibrous or gliotic tissue around the
neuroimplant, either alone or in combination with a fibrosis (or
gliosis) inhibiting agent/composition, is formed from reactants
comprising either one or both of pentaerythritol poly(ethylene
glycol)ether tetra-sulfhydryl] (4-armed thiol PEG, which includes
structures having a linking group(s) between a sulfhydryl group(s)
and the terminus of the polyethylene glycol backbone) and
pentaerythritol poly(ethylene glycol)ether tetra-succinimidyl
glutarate] (4-armed NHS PEG, which again includes structures having
a linking group(s) between a NHS group(s) and the terminus of the
polyethylene glycol backbone) as reactive reagents. Another
preferred composition comprises either one or both of
pentaerythritol poly(ethylene glycol)ether tetra-amino] (4-armed
amino PEG, which includes structures having a linking group(s)
between an amino group(s) and the terminus of the polyethylene
glycol backbone) and pentaerythritol poly(ethylene glycol)ether
tetra-succinimidyl glutarate] (4-armed NHS PEG, which again
includes structures having a linking group(s) between a NHS
group(s) and the terminus of the polyethylene glycol backbone) as
reactive reagents. Chemical structures for these reactants are
shown in, e.g., U.S. Pat. No. 5,874,500. Optionally, collagen or a
collagen derivative (e.g., methylated collagen) is added to the
poly(ethylene glycol)-containing reactant(s) to form a preferred
crosslinked matrix that can serve as a polymeric carrier for a
therapeutic agent or a stand-alone composition to help prevent the
formation of fibrous or gliotic tissue around the neuroimplant.
[0134] It should be apparent to one of skill in the art that
potentially any anti-scarring (or anti-gliotic) agent described
above may be utilized alone, or in combination, in the practice of
this embodiment. As neurostimulator devices are made in a variety
of configurations and sizes, the exact dose administered will vary
with device size, surface area and design. However, certain
principles can be applied in the application of this art. Drug dose
can be calculated as a function of dose per unit area (of the
portion of the device being coated), total drug dose administered
can be measured and appropriate surface concentrations of active
drug can be determined. Regardless of the method of application of
the drug to the device (i.e., as a coating or infiltrated into the
surrounding tissue), the fibrosis-inhibiting (or
gliosis-inhibiting) agents, used alone or in combination, may be
administered under the following dosing guidelines:
[0135] Drugs and dosage: Exemplary therapeutic agents that may be
used include, but are not limited to: antimicrotubule agents
including taxanes (e.g., paclitaxel and docetaxel), other
microtubule stabilizing agents, mycophenolic acid, rapamycin and
vinca alkaloids (e.g., vinblastine and vincristine sulfate). Drugs
are to be used at concentrations that range from a single systemic
dose (e.g., the dose used in oral or i.v. administration) to a
fraction of a single systemic dose (e.g., 50%, 10%, 5%, or even
less than 1% of the concentration typically used in a single
systemic dose application). Preferably, the drug is released in
effective concentrations for a period ranging from 1-90 days.
Antimicrotubule agents including taxanes, such as paclitaxel and
analogues and derivatives (e.g., docetaxel) thereof, and vinca
alkaloids, including vinblastine and vincristine sulfate and
analogues and derivatives thereof, should be used under the
following parameters: total dose not to exceed 10 mg (range of 0.1
pg to 10 mg); preferred total dose 1 .mu.g to 3 mg. Dose per unit
area of the device of 0.05 .mu.g-10 .mu.g per mm.sup.2; preferred
dose/unit area of 0.20 .mu.g/mm.sup.2-5 .mu.g/mm.sup.2. Minimum
concentration of 10.sup.-9-10.sup.-4 M of drug is to be maintained
on the device surface. Immunomodulators including sirolimus and
everolimus. Sirolimus (i.e., rapamycin, RAPAMUNE): Total dose not
to exceed 10 mg (range of 0.1 .mu.g to 10 mg); preferred 10 .mu.g
to 1 mg. The dose per unit area of 0.1 .mu.g-100 .mu.g per
mm.sup.2; preferred dose of 0.5 .mu.g/mm.sup.2 -10 .mu.g/mm.sup.2.
Minimum concentration of 10.sup.-8-10.sup.-4 M is to be maintained
on the device surface. Everolimus and derivatives and analogues
thereof: Total dose should not exceed 10 mg (range of 0.1 .mu.g to
10 mg); preferred 10 .mu.g to 1 mg. The dose per unit area of 0.1
.mu.g-100 .mu.g per mm.sup.2 of surface area; preferred dose of 0.3
.mu.g/mm.sup.2 l -10 .mu.g/mm.sup.2. Minimum concentration of
10.sup.-8-10.sup.-4 M of everolimus is to be maintained on the
device surface. Inosine monophosphate dehydrogenase inhibitors
(e.g., mycophenolic acid, 1-alpha-25 dihydroxy vitamin D.sub.3) and
analogues and derivatives thereof: total dose not to exceed 2000 mg
(range of 10.0 .mu.g to 2000 mg); preferred 10 .mu.g to 300 mg. The
dose per unit area of the device of 1.0 .mu.g-1000 .mu.g per
mm.sup.2; preferred dose of 2.5 .mu.g/mm.sup.2-500 .mu.g/mm.sup.2.
Minimum concentration of 10.sup.-8-10.sup.-3 M of mycophenolic acid
is to be maintained on the device surface.
[0136] 2) Cardiac Rhythm Management (CRM) Devices
[0137] In another aspect, the electrical device may be a cardiac
pacemaker device where a pulse generator delivers an electrical
impulse to myocardial tissue (often specialized conduction fibres)
via an implanted lead in order to regulate cardiac rhythm.
Typically, electrical leads are composed of a connector assembly, a
lead body (i.e., conductor) and an electrode. Electrical leads may
be unipolar, in which they are adapted to provide effective therapy
with only one electrode. Multi-polar leads are also available,
including bipolar, tripolar and quadripolar leads. Electrical leads
may also have insulating sheaths which may include polyurethane or
silicone-rubber coatings. Representative examples of electrical
leads include, without limitation, medical leads, cardiac leads,
pacer leads, pacing leads, pacemaker leads, endocardial leads,
endocardial pacing leads, cardioversion/defibrillator leads,
cardioversion leads, epicardial leads, epicardial defibrillator
leads, patch defibrillators, patch leads, electrical patch,
transvenous leads, active fixation leads, passive fixation leads
and sensing leads Representative examples of CRM devices that
utilize electrical leads include: pacemakers, LVAD's,
defibrillators, implantable sensors and other electrical cardiac
stimulation devices.
[0138] There are numerous pacemaker devices where the occurrence of
a fibrotic reaction will adversely affect the functioning of the
device or cause damage to the myocardial tissue. Typically,
fibrotic encapsulation of the pacemaker lead (or the growth of
fibrous tissue between the lead and the target myocardial tissue)
slows, impairs, or interrupts electrical transmission of the
impulse from the device to the myocardium. For example, fibrosis is
often found at the electrode-myocardial interfaces in the heart,
which may be attributed to electrical injury from focal points on
the electrical lead. The fibrotic injury may extend into the
tricuspid valve, which may lead to perforation. Fibrosis may lead
to thrombosis of the subclavian vein; a condition which may be
life-threatening. Electrical leads that release therapeutic agent
for reducing scarring at the electrode-tissue interface may help
prolong the clinical performance of these devices. Not only can
fibrosis cause the device to function suboptimally or not at all,
it can cause excessive drain on battery life as increased energy is
required to overcome the electrical resistance imposed by the
intervening scar tissue. Similarly, fibrotic encapsulation of the
sensing components of a rate-responsive pacemaker (described below)
can impair the ability of the pacemaker to identify and correct
rhythm abnormalities leading to inappropriate pacing of the heart
or the failure to function correctly when required.
[0139] Several different electrical pacing devices are used in the
treatment of various cardiac rhythm abnormalities including
pacemakers, implantable cardioverter defibrillators (ICD), left
ventricular assist devices (LVAD), and vagus nerve stimulators
(stimulates the fibers of the vagus nerve which in turn innervate
the heart). The pulse generating portion of device sends electrical
impulses via implanted leads to the muscle (myocardium) or
conduction tissue of the heart to affect cardiac rhythm or
contraction. Pacing can be directed to one or more chambers of the
heart. Cardiac pacemakers may be used to block, mask, or stimulate
electrical signals in the heart to treat dysfunctions, including,
without limitation, atrial rhythm abnormalities, conduction
abnormalities and ventricular rhythm abnormalities. ICDs are used
to depolarize the ventricals and re-establish rhythm if a
ventricular arrhythmia occurs (such as asystole or ventricular
tachycardia) and LVADs are used to assist ventricular contraction
in a failing heart.
[0140] Representative examples of patents which describe pacemakers
and pacemaker leads include U.S. Pat. Nos. 4,662,382, 4,782,836,
4,856,521, 4,860,751, 5,101,824, 5,261,419, 5,284,491, 6,055,454,
6,370,434, and 6,370,434. Representative examples of electrical
leads include those found on a variety of cardiac devices, such as
cardiac stimulators (see e.g., U.S. Pat. Nos. 6,584,351 and
6,115,633), pacemakers (see e.g., U.S. Pat. Nos. 6,564,099;
6,246,909 and 5,876,423), implantable cardioverter-defibrillators
(ICDs), other defibrillator devices (see e.g., U.S. Pat. No.
6,327,499), defibrillator or demand pacer catheters (see e.g., U.S.
Pat. No. 5,476,502) and Left Ventricular Assist Devices (see e.g.,
U.S. Pat. No. 5,503,615).
[0141] Cardiac rhythm devices, and in particular the lead(s) that
deliver the electrical pulsation, must be positioned in a very
precise manner to ensure that stimulation is delivered to the
correct anatomical location in the heart. All, or parts, of a
pacing device can migrate following surgery, or excessive scar
tissue growth can occur around the lead, which can lead to a
reduction in the performance of these devices (as described
previously). Cardiac rhythm management devices that release a
therapeutic agent for reducing scarring at the electrode-tissue
interface can be used to increase the efficacy and/or the duration
of activity (particularly for fully-implanted, battery-powered
devices) of the implant. Accordingly, the present invention
provides cardiac leads that are coated with an anti-scarring agent
or a composition that includes an anti-scarring agent.
[0142] For greater clarity, several specific cardiac rhythm
management devices and treatments will be described in greater
detail including:
[0143] a) Cardiac Pacemakers
[0144] Cardiac rhythm abnormalities are extremely common in
clinical practice and the incidence increases in frequency with
both age and the presence of underlying coronary artery disease or
myocardial infarction. A litany of arrythmias exists, but they are
generally categorized into conditions where the heart beats too
slowly (bradyarrythmias--such heart block, sinus node dysfunction)
or too quickly (tachyarrhythmias--such as atrial fibrillation, WPW
syndrome, ventricular fibrillation). A pacemaker functions by
sending an electrical pulse (a pacing pulse) that travels via an
electrical lead to the electrode (at the tip of the lead) which
delivers an electrical impulse to the heart that initiates a
heartbeat. The leads and electrodes can be located in one chamber
(either the right atrium or the right ventricle--called
single-chamber pacemakers) or there can be electrodes in both the
right atrium and the right ventricle (called dual-chamber
pacemakers). Electrical leads may be implanted on the exterior of
the heart (e.g., epicardial leads) by a surgical procedure, or they
can be connected to the endocardial surface of the heart via a
catheter, guidewire or stylet. In some pacemakers, the device
assumes the rhythm generating function of the heart and fires at a
regular rate. In other pacemakers, the device merely augments the
heart's own pacing function and acts "on demand" to provide pacing
assistance as required (called "adaptive-rate" pacemakers); the
pacemaker receives feedback on heart rhythm (and hence when to
fire) from an electrode sensor located on the lead. Other
pacemakers, called rate responsive pacemakers, have special sensors
that detect changes in body activity (such as movement of the arms
and legs, respiratory rate) and adjust pacing up or down
accordingly.
[0145] Numerous pacemakers and pacemaker leads are suitable for use
in this invention. For example, the pacing lead may have an
increased resistance to fracture by being composed of an elongated
coiled conductor mounted within a lumen of a lead body whereby it
may be coupled electrically to a stranded conductor. See e.g., U.S.
Pat. Nos. 6,061,598 and 6,018,683. The pacing lead may have a
coiled conductor with an insulated sheath, which has a resistance
to crush fatigue in the region between the rib and clavicle. See
e.g., U.S. Pat. No. 5,800,496. The pacing lead may be expandable
from a first, shorter configuration to a second, longer
configuration by being composed of slideable inner and outer
overlapping tubes containing a conductor. See e.g., U.S. Pat. No.
5,897,585. The pacing lead may have the means for temporarily
making the first portion of the lead body stiffer by using a
magnet-rheologic fluid in a cavity that stiffens when exposed to a
magnetic field. See e.g., U.S. Pat. No.5,800,497. The pacing lead
may be a coil configuration composed of a plurality of wires or
wire bundles made from a duplex titanium alloy. See e.g., U.S. Pat.
No. 5,423,881. The pacing lead may be composed of a wire wound in a
coil configuration with the wire composed of stainless steel having
a composition of at least 22% nickel and 2% molybdenum. See e.g.,
U.S. Pat. No. 5,433,744. Other pacing leads are described in, e.g.,
U.S. Pat. Nos. 6,489,562; 6,289,251 and 5,957,967.
[0146] In another aspect, the electrical lead used in the practice
of this invention may have an active fixation element for
attachment to tissue. For example, the electrical lead may have a
rigid fixation helix with microgrooves that are dimensioned to
minimize the foreign body response following implantation. See
e.g., U.S. Pat. No. 6,078,840. The electrical lead may have an
electrode/anchoring portion with a dual tapered self-propelling
spiral electrode for attachment to vessel wall. See e.g., U.S. Pat.
No. 5,871,531. The electrical lead may have a rigid insulative
electrode head carrying a helical electrode. See e.g., U.S. Pat.
No. 6,038,463. The electrical lead may have an improved anchoring
sleeve designed with an introducer sheath to minimize the flow of
blood through the sheath during introduction. See e.g., U.S. Pat.
No. 5,827,296. The electrical lead may be composed of an insulated
electrical conductive portion and a lead-in securing section having
a longitudinally rigid helical member which may be screwed into
tissue. See e.g., U.S. Pat. No. 4,000,745.
[0147] Suitable leads for use in the practice of this invention
also include multi-polar leads with multiple electrodes connected
to the lead body. For example, the electrical lead may be a
multi-electrode lead whereby the lead has two internal conductors
and three electrodes with two electrodes coupled by a capacitor
integral with the lead. See e.g., U.S. Pat. No. 5,824,029. The
electrical lead may be a lead body with two straight sections and a
bent third section with associated conductors and electrodes
whereby the electrodes are bipolar. See e.g., U.S. Pat. No.
5,995,876. In another aspect, the electrical lead may be implanted
by using a catheter, guidewire or stylet. For example, the
electrical lead may be composed of an elongated insulative lead
body having a lumen with a conductor mounted within the lead body
and a resilient seal having an expandable portion through which a
guidewire may pass. See e.g., U.S. Pat. No. 6,192,280.
[0148] Commercially available pacemakers suitable for the practice
of the invention include the KAPPA SR 400 Series single-chamber
rate-responsive pacemaker system, the KAPPA DR 400 Series
dual-chamber rate-responsive pacemaker system, the KAPPA 900 and
700 Series single-chamber rate-responsive pacemaker system, and the
KAPPA 900 and 700 Series dual-chamber rate-responsive pacemaker
system by Medtronic, Inc. Medtronic pacemaker systems utilize a
variety leads including the CAPSURE Z Novus, CAPSUREFIX Novus,
CAPSUREFIX, CAPSURE SP Novus, CAPSURE SP, CAPSURE EPI and the
CAPSURE VDD which may be suitable for coating with a
fibrosis-inhibiting agent. Pacemaker systems and associated leads
that are made by Medtronic are described in, e.g., U.S. Pat. Nos.
6,741,893; 5,480,441; 5,411,545; 5,324,310; 5,265,602; 5,265,601;
5,241,957 and 5,222,506. Medtronic also makes a variety of
steroid-eluting leads including those described in, e.g., U.S. Pat.
Nos. 5,987,746; 6,363,287; 5,800,470; 5,489,294; 5,282,844 and
5,092,332. The INSIGNIA single-chamber and dual-chamber system,
PULSAR MAX II DR dual-chamber adaptive-rate pacemaker, PULSAR MAX
II SR single-chamber adaptive-rate pacemaker, DISCOVERY II DR
dual-chamber adaptive-rate pacemaker, DISCOVERY II SR
single-chamber adaptive-rate pacemaker, DISCOVERY II DDD
dual-chamber pacemaker, and the DISCOVERY II SSI dingle-chamber
pacemaker systems made by Guidant Corp. (Indianapolis, Ind.) are
also suitable pacemaker systems for the practice of this invention.
Once again, the leads from the Guidant pacemaker systems may be
suitable for coating with a fibrosis-inhibiting agent. Pacemaker
systems and associated leads that are made by Guidant are described
in, e.g., U.S. Pat. Nos. 6,473,648; 6,345,204; 6,321,122;
6,152,954; 5,769,881; 5,284,136; 5,086,773 and 5,036,849. The
AFFINITY DR, AFFINITY VDR, AFFINITY SR, AFFINITY DC, ENTITY,
IDENTITY, IDENTITY ADX, INTEGRITY, INTEGRITY .mu.DR, INTEGRITY ADx,
MICRONY, REGENCY, TRILOGY, and VERITY ADx, pacemaker systems and
leads from St. Jude Medical, Inc. (St. Paul, Minn.) may also be
suitable for use with a fibrosis-inhibiting coating to improve
electrical transmission and sensing by the pacemaker leads.
Pacemaker systems and associated leads that are made by St. Jude
Medical are described in, e.g., U.S. Pat. Nos. 6,763,266;
6,760,619; 6,535,762; 6,246,909; 6,198,973; 6,183,305; 5,800,468
and 5,716,390. Alternatively, the fibrosis-inhibiting agent may be
infiltrated into the region around the electrode-cardiac muscle
interface under the present invention. It should be obvious to one
of skill in the art that commercial pacemakers not specifically
sited as well as next-generation and/or subsequently developed
commercial pacemaker products are to be anticipated and are
suitable for use under the present invention.
[0149] Regardless of the specific design features, for pacemakers
to be effective in the management of cardiac rhythm disorders, the
leads must be accurately positioned adjacent to the targeted
cardiac muscle tissue. If excessive scar tissue growth or
extracellular matrix deposition occurs around the leads, efficacy
can be compromised. Pacemaker leads that release a therapeutic
agent able to reduce scarring at the electrode-tissue and/or
sensor-tissue interface, can increase the efficiency of impulse
transmission and rhythm sensing, thereby increasing efficacy and
battery longevity. In one aspect, the device includes pacemaker
leads that are coated with an anti-scarring agent or a composition
that includes an anti-scarring agent. As an alternative to this, or
in addition to this, a composition that includes an anti-scarring
agent can be infiltrated into the myocardial tissue surrounding the
lead.
[0150] b) Implantable Cardioverter Defibrillator (ICD) Systems
[0151] Implantable cardioverter defibrillator (ICD) systems are
similar to pacemakers (and many include a pacemaker system), but
are used for the treatment of tachyarrhythmias such as ventricular
tachycardia or ventricular fibrillation. An ICD consists of a
mini-computer powered by a battery which is connected to a
capacitor to helps the ICD charge and store enough energy to
deliver therapy when needed. The ICD uses sensors to monitor the
activity of the heart and the computer analysizes the data to
determine when and if an arrhythmia is present. An ICD lead, which
is inserted via a vein (called "transvenous" leads; in some systems
the lead is implanted surgically--called an epicardial lead--and
sewn onto the surface of the heart), connects into the
pacing/computer unit. The lead, which is usually placed in the
right ventricle, consists of an insulated wire and an electrode tip
that contains a sensing component (to detect cardiac rhythm) and a
shocking coil. A single-chamber ICD has one lead placed in the
ventricle which defibrillates and paces the ventricle, while a
dual-chamber ICD defibrillates the ventricle and paces the atrium
and the ventricle. In some cases, an additional lead is required
and is placed under the skin next to the rib cage or on the surface
of the heart. In patients who require tachyarrhythmia management of
the ventricle and atrium, a second coil is placed in the atrium to
treat atrial tachycardia, atrial fibrillation and other
arrhythmias. If a tachyarrhythmia is detected, a pulse is generated
and propagated via the lead to the shocking coil which delivers a
charge sufficient to depolarize the muscle and cardiovert or
defibrillate the heart.
[0152] Several ICD systems have been described and are suitable for
use in the practice of this invention. Representative examples of
ICD's and associated components are described in U.S. Pat. Nos.
3,614,954, 3,614,955, 4,375,817, 5,314,430, 5,405,363, 5,607,385,
5,697,953, 5,776,165, 6,067,471, 6,169,923, and 6,152,955. Several
ICD leads are suitable for use in the practice of this invention.
For example, the defibrillator lead may be a linear assembly of
sensors and coils formed into a loop which includes a conductor
system for coupling the loop system to a pulse generator. See e.g.,
U.S. Pat. No. 5,897,586. The defibrillator lead may have an
elongated lead body with an elongated electrode extending from the
lead body, such that insulative tubular sheaths are slideably
mounted around the electrode. See e.g., U.S. Pat. No. 5,919,222.
The defibrillator lead may be a temporary lead with a mounting pad
and a temporarily attached conductor with an insulative sleeve
whereby a plurality of wire electrodes are mounted. See e.g., U.S.
Pat. No. 5,849,033. Other defibrillator leads are described in,
e.g., U.S. Pat. No. 6,052,625. In another aspect, the electrical
lead may be adapted to be used for pacing, defibrillating or both
applications. For example, the electrical lead may be an
electrically insulated, elongated, lead body sheath enclosing a
plurality of lead conductors that are separated from contacting one
another. See e.g., U.S. Pat. No. 6,434,430. The electrical lead may
be composed of an inner lumen adapted to receive a stiffening
member (e.g., guide wire) that delivers fluoro-visible media. See
e.g., U.S. Pat. No. 6,567,704. The electrical lead may be a
catheter composed of an elongated, flexible, electrically
nonconductive probe contained within an electrically conductive
pathway that transmits electrical signals, including a
defibrillation pulse and a pacer pulse, depending on the need that
is sensed by a governing element. See e.g., U.S. Pat. No.
5,476,502. The electrical lead may have a low electrical resistance
and good mechanical resistance to cyclical stresses by being
composed of a conductive wire core formed into a helical coil
covered by a layer of electrically conductive material and an
electrically insulating sheath covering. See e.g., U.S. Pat. No.
5,330,521. Other electrical leads that may be adapted for use in
pacing and/or defibrillating applications are described in, e.g.,
U.S. Pat. Nos. 6,556,873.
[0153] Commercially available ICDs suitable for the practice of the
invention include the GEM III DR dual-chamber ICD, GEM III VR ICD,
GEM II ICD, GEM ICD, GEM III AT atrial and ventricular arrhythmia
ICD, JEWEL AF dual-chamber ICD, MICRO JEWEL ICD, MICRO JEWEL II
ICD, JEWEL Plus ICD, JEWEL ICD, JEWEL ACTIVE CAN ICD, JEWEL PLUS
ACTIVE CAN ICD, MAXIMO DR ICD, MAXIMO VR ICD, MARQUIS DR ICD,
MARQUIS VR system, and the INTRINSIC dual-chamber ICD by Medtronic,
Inc. Medtronic ICD systems utilize a variety leads including the
SPRINT FIDELIS, SPRINT QUATRO SECURE steroid-eluting bipolar lead,
Subcutaneous Lead System Model 6996SQ subcutaneous lead, TRANSVENE
6937A transvenous lead, and the 6492 Unipolar Atrial Pacing Lead
which may be suitable for coating with a fibrosis-inhibiting agent.
ICD systems and associated leads that are made by Medtronic are
described in, e.g., U.S. Pat. Nos. 6,038,472; 5,849,031; 5,439,484;
5,314,430; 5,165,403; 5,099,838 and 4,708,145. The VITALITY 2 DR
dual-chamber ICD, VITALITY 2 VR single-chamber ICD, VITALITY AVT
dual-chamber ICD, VITALITY DS dual-chamber ICD, VITALITY DS VR
single-chamber ICD, VITALITY EL dual-chamber ICD, VENTAK PRIZM 2 DR
dual-chamber ICD, and VENTAK PRIZM 2 VR single-chamber ICD systems
made by Guidant Corp. are also suitable ICD systems for the
practice of this invention. Once again, the leads from the Guidant
ICD systems may be suitable for coating with a fibrosis-inhibiting
agent. Guidant sells the FLEXTEND Bipolar Leads, EASYTRAK Lead
System, FINELINE Leads, and ENDOTAK RELIANCE ICD Leads. ICD systems
and associated leads that are made by Guidant are described in,
e.g., U.S. Pat. Nos. 6,574,505; 6,018,681; 5,697,954; 5,620,451;
5,433,729; 5,350,404; 5,342,407; 5,304,139 and 5,282,837.
Biotronik, Inc. (Germany) sells the POLYROX Endocardial Leads,
KENTROX SL Quadripolar ICD Leads, AROX Bipolar Leads, and MAPOX
Bipolar Epicardial Leads (see e.g., U.S. Pat. Nos. 6,449,506;
6,421,567; 6,418,348; 6,236,893 and 5,632,770). The CONTOUR MD ICD,
PHOTON .mu. DR ICD, PHOTON .mu. VR ICD, ATLAS+ HF ICD, EPIC HF ICD,
EPIC+ HF ICD systems and leads from St. Jude Medical may also be
suitable for use with a fibrosis-inhibiting coating to improve
electrical transmission and sensing by the ICD leads (see e.g.,
U.S. Pat. Nos. 5,944,746; 5,722,994; 5,662,697; 5,542,173;
5,456,706 and 5,330,523). Alternatively, the fibrosis-inhibiting
agent may be infiltrated into the region around the
electrode-cardiac muscle interface under the present invention. It
should be obvious to one of skill in the art that commercial ICDs
not specifically sited as well as next-generation and/or
subsequently developed commercial ICD products are to be
anticipated and are suitable for use under the present
invention.
[0154] Regardless of the specific design features, for ICDs to be
effective in the management of cardiac rhythm disorders, the leads
must be accurately positioned adjacent to the targeted cardiac
muscle tissue. If excessive scar tissue growth or extracellular
matrix deposition occurs around the leads, efficacy can be
compromised. ICD leads that release a therapeutic agent able to
reduce scarring at the electrode-tissue and/or sensor-tissue
interface, can increase the efficiency of impulse transmission and
rhythm sensing, thereby increasing efficacy, preventing
inappropriate cardioversion, and improving battery longevity. In
one aspect, the device includes ICD leads that are coated with an
anti-scarring agent or a composition that includes an anti-scarring
agent. As an alternative to this, or in addition to this, a
composition that includes an anti-scarring agent can be infiltrated
into the myocardial tissue surrounding the lead.
[0155] c) Vagus Nerve Stimulation for the Treatment of
Arrhythmia
[0156] In another aspect, a neurostimulation device may be used to
stimulate the vagus nerve and affect the rhythm of the heart. Since
the vagus nerve provides innervation to the heart, including the
conduction system (including the SA node), stimulation of the vagus
nerve may be used to treat conditions such as supraventricular
arrhythmias, angina pectoris, atrial tachycardia, atrial flutter,
atrial fibrillation and other arrhythmias that result in low
cardiac output.
[0157] As described above, in VNS a bipolar electrical lead is
surgically implanted such that it transmits electrical stimulation
from the pulse generator to the left vagus nerve in the neck. The
pulse generator is an implanted, lithium carbon monofluoride
battery-powered device that delivers a precise pattern of
stimulation to the vagus nerve. The pulse generator can be
programmed (using a programming wand) by the cardiologist to treat
a specific arrhythmia.
[0158] Products such as these have been described, for example, in
U.S. Pat. Nos. 6,597,953 and 6,615,085. For example, the
neurostimulator may be a vagal-stimulation apparatus which
generates pulses at a frequency that varies automatically based on
the excitation rates of the vagus nerve. See e.g., U.S. Pat. Nos.
5,916,239 and 5,690,681. The neurostimulator may be an apparatus
that detects characteristics of tachycardia based on an electrogram
and delivers a preset electrical stimulation to the nervous system
to depress the heart rate. See e.g., U.S. Pat. No. 5,330,507. The
neurostimulator may be an implantable heart stimulation system
composed of two sensors, one for atrial signals and one for
ventricular signals, and a pulse generator and control unit, to
ensure sympatho-vagal stimulation balance. See e.g., U.S. Pat. No.
6,477,418. The neurostimulator may be a device that applies
electrical pulses to the vagus nerve at a programmable frequency
that is adjusted to maintain a lower heart rate. See e.g., U.S.
Pat. No. 6,473,644. The neurostimulator may provide electrical
stimulation to the vagus nerve to induce changes to
electroencephalogram readings as a treatment for epilepsy, while
controlling the operation of the heart within normal parameters.
See e.g., U.S. Pat. No. 6,587,727.
[0159] A commercial example of a VNS system is the product produced
by Cyberonics Inc. that consists of the Model 300 and Model 302
leads, the Model 101 and Model 102R pulse generators, the Model 201
programming wand and Model 250 programming software, and the Model
220 magnets. These products manufactured by Cyberonics, Inc. may be
described, for example, in U.S. Pat. Nos. 5,928,272; 5,540,730 and
5,299,569.
[0160] Regardless of the specific design features, for vagal nerve
stimulation to be effective in arrhythmias, the leads must be
accurately positioned adjacent to the left vagus nerve. If
excessive scar tissue growth or extracellular matrix deposition
occurs around the VNS leads, this can reduce the efficacy of the
device. VNS devices that release a therapeutic agent able to
reducing scarring at the electrode-tissue interface can increase
the efficiency of impulse transmission and increase the duration
that these devices function clinically. In one aspect, the device
includes VNS devices and/or leads that are coated with an
anti-scarring agent or a composition that includes an anti-scarring
agent. As an alternative to this, or in addition to this, a
composition that includes an anti-scarring agent can be infiltrated
into the tissue surrounding the vagus nerve where the lead will be
implanted.
[0161] Although numerous cardiac rhythm management (CRM) devices
have been described above, all possess similar design features and
cause similar unwanted fibrous tissue reactions following
implantation. The CRM device, particularly the lead(s), must be
positioned in a very precise manner to ensure that stimulation is
delivered to the correct anatomical location within the atrium
and/or ventricle. All, or parts, of a CRM device can migrate
following surgery, or excessive scar tissue growth can occur around
the implant, which can lead to a reduction in the performance of
these devices. CRM devices that release a therapeutic agent for
reducing scarring at the electrode-tissue interface can be used to
increase the efficacy and/or the duration of activity of the
implant (particularly for fully-implanted, battery-powered
devices). In one aspect, the present invention provides CRM devices
that include a fibrosis-inhibiting agent or a composition that
includes a fibrosis-inhibiting agent. Numerous polymeric and
non-polymeric delivery systems for use in CRM devices have been
described above. These compositions can further include one or more
fibrosis-inhibiting agents such that the overgrowth of granulation
or fibrous tissue is inhibited or reduced.
[0162] Methods for incorporating fibrosis-inhibiting compositions
onto or into CRM devices include: (a) directly affixing to the CRM
device, lead and/or electrode a fibrosis-inhibiting composition
(e.g., by either a spraying process or dipping process as described
above, with or without a carrier), (b) directly incorporating into
the CRM device, lead and/or electrode a fibrosis-inhibiting
composition (e.g., by either a spraying process or dipping process
as described above, with or without a carrier (c) by coating the
CRM device, lead and/or electrode with a substance such as a
hydrogel which will in turn absorb the fibrosis-inhibiting
composition, (d) by interweaving fibrosis-inhibiting composition
coated thread (or the polymer itself formed into a thread) into the
device, lead and/or electrode structure, (e) by inserting the CRM
device, lead and/or electrode into a sleeve or mesh which is
comprised of, or coated with, a fibrosis-inhibiting composition,
(f) constructing the CRM device, lead and/or electrode itself (or a
portion of the lead and/or electrode) with a fibrosis-inhibiting
composition, or (g) by covalently binding the fibrosis-inhibiting
agent directly to the CRM device, lead and/or electrode surface, or
to a linker (small molecule or polymer) that is coated or attached
to the device, lead and/or electrode surface. Each of these methods
illustrates an approach for combining an electrical device with a
fibrosis-inhibiting (also referred to herein as an anti-scarring)
or gliosis-inhibiting agent according to the present invention.
[0163] For CRM devices, leads and electrodes, the coating process
can be performed in such a manner as to: (a) coat the non-electrode
portions of the lead; (b) coat the electrode portion of the lead;
or (c) coat all or parts of the entire device with the
fibrosis-inhibiting composition. In addition to, or alternatively,
the fibrosis-inhibiting agent can be mixed with the materials that
are used to make the CRM device, lead and/or electrode such that
the fibrosis-inhibiting agent is incorporated into the final
product. In these manners, a medical device may be prepared which
has a coating, where the coating is, e.g., uniform, non-uniform,
continuous, discontinuous, or patterned.
[0164] In another aspect, a CRM device may include a plurality of
reservoirs within its structure, each reservoir configured to house
and protect a therapeutic drug. The reservoirs may be formed from
divets in the device surface or micropores or channels in the
device body. In one aspect, the reservoirs are formed from voids in
the structure of the device. The reservoirs may house a single type
of drug or more than one type of drug. The drug(s) may be
formulated with a carrier (e.g., a polymeric or non-polymeric
material) that is loaded into the reservoirs. The filled reservoir
can function as a drug delivery depot which can release drug over a
period of time dependent on the release kinetics of the drug from
the carrier. In certain embodiments, the reservoir may be loaded
with a plurality of layers. Each layer may include a different drug
having a particular amount (dose) of drug, and each layer may have
a different composition to further tailor the amount of drug that
is released from the substrate. The multi-layered carrier may
further include a barrier layer that prevents release of the
drug(s). The barrier layer can be used, for example, to control the
direction that the drug elutes from the void. Thus, the coating of
the medical device may directly contact the electrical device, or
it may indirectly contact the electrical device when there is
something, e.g., a polymer layer, that is interposed between the
electrical device and the coating that contains the
fibrosis-inhibiting agent.
[0165] In addition to, or as an alternative to incorporating a
fibrosis-inhibiting agent onto, or into, the CRM device, the
fibrosis-inhibiting agent can be applied directly or indirectly to
the tissue adjacent to the CRM device (preferably near the
electrode-tissue interface). This can be accomplished by applying
the fibrosis-inhibiting agent, with or without a polymeric,
non-polymeric, or secondary carrier: (a) to the lead and/or
electrode surface (e.g., as an injectable, paste, gel, or mesh)
during the implantation procedure; (b) to the surface of the tissue
(e.g., as an injectable, paste, gel, in situ forming gel, or mesh)
prior to, immediately prior to, or during, implantation of the CRM
device and/or the lead; (c) to the surface of the CRM lead and/or
electrode and/or to the tissue surrounding the implanted lead or
electrode (e.g., as an injectable, paste, gel, in situ forming gel,
or mesh) immediately after the implantation of the CRM device, lead
and/or electrode; (d) by topical application of the anti-fibrosis
agent into the anatomical space where the CRM device, lead and/or
electrode will be placed (particularly useful for this embodiment
is the use of polymeric carriers which release the
fibrosis-inhibiting agent over a period ranging from several hours
to several weeks--fluids, suspensions, emulsions, microemulsions,
microspheres, pastes, gels, microparticulates, sprays, aerosols,
solid implants and other formulations which release the agent can
be delivered into the region where the CRM device, lead and/or
electrode will be inserted); (e) via percutaneous injection into
the tissue surrounding the CRM device, lead and/or electrode as a
solution, as an infusate, or as a sustained release preparation;
(f) by any combination of the aforementioned methods. Combination
therapies (i.e., combinations of therapeutic agents and
combinations with antithrombotic and/or antiplatelet agents) can
also be used.
[0166] It should be noted that certain polymeric carriers
themselves can help prevent the formation of fibrous tissue around
the CRM lead and electrode. These carriers (to be described
shortly) are particularly useful for the practice of this
embodiment, either alone, or in combination with a
fibrosis-inhibiting composition. The following polymeric carriers
can be infiltrated (as described in the previous paragraph) into
the vicinity of the CRM device, lead and/or electrode-tissue
interface and include: (a) sprayable collagen-containing
formulations such as COSTASIS and CT3, either alone, or loaded with
a fibrosis-inhibiting agent, applied to the implantation site (or
the implant/device surface); (b) sprayable PEG-containing
formulations such as COSEAL, FOCALSEAL, SPRAYGEL or DURASEAL,
either alone, or loaded with a fibrosis-inhibiting agent, applied
to the implantation site (or the implant/device surface); (c)
fibrinogen-containing formulations such as FLOSEAL or TISSEAL,
either alone, or loaded with a fibrosis-inhibiting agent, applied
to the implantation site (or the implant/device surface); (d)
hyaluronic acid-containing formulations such as RESTYLANE,
HYLAFORM, PERLANE, SYNVISC, SEPRAFILM, SEPRACOAT, loaded with a
fibrosis-inhibiting agent applied to the implantation site (or the
implant/device surface); (e) polymeric gels for surgical
implantation such as REPEL or FLOWGEL loaded with a
fibrosis-inhibiting agent applied to the implantation site (or the
implant/device surface); (f) orthopedic "cements" used to hold
prostheses and tissues in place loaded with a fibrosis-inhibiting
agent applied to the implantation site (or the implant/device
surface), such as OSTEOBOND, low viscosity cement (LVC), SIMPLEX P,
PALACOS, and ENDURANCE; (g) surgical adhesives containing
cyanoacrylates such as DERMABOND, INDERMIL, GLUSTITCH, TISSUMEND,
VETBOND, HISTOACRYL BLUE and ORABASE SOOTHE-N-SEAL LIQUID
PROTECTANT, either alone, or loaded with a fibrosis-inhibiting
agent, applied to the implantation site [or the implant/device
surface); (h) implants containing hydroxyapatite for synthetic bone
material such as calcium sulfate, VITOSS and CORTOSS (Orthovita)]
loaded with a fibrosis-inhibiting agent applied to the implantation
site (or the implant/device surface); (i) other biocompatible
tissue fillers loaded with a fibrosis-inhibiting agent, such as
those made by BioCure, Inc., 3M Company and Neomend, Inc., applied
to the implantation site (or the implant/device surface); (j)
polysaccharide gels such as the ADCON series of gels either alone,
or loaded with a fibrosis-inhibiting agent, applied to the
implantation site (or the implant/device surface); and/or (k)
films, sponges or meshes such as INTERCEED, VICRYL mesh, and
GELFOAM loaded with a fibrosis-inhibiting agent applied to the
implantation site (or the implant/device surface).
[0167] A preferred polymeric matrix which can be used to help
prevent the formation of fibrous or gliotic tissue around the CRM
lead and electrode, either alone or in combination with a fibrosis
(or gliosis) inhibiting agent/composition, is formed from reactants
comprising either one or both of pentaerythritol poly(ethylene
glycol)ether tetra-sulfhydryl] (4-armed thiol PEG, which includes
structures having a linking group(s) between a sulfhydryl group(s)
and the terminus of the polyethylene glycol backbone) and
pentaerythritol poly(ethylene glycol)ether tetra-succinimidyl
glutarate] (4-armed NHS PEG, which again includes structures having
a linking group(s) between a NHS group(s) and the terminus of the
polyethylene glycol backbone) as reactive reagents. Another
preferred composition comprises either one or both of
pentaerythritol poly(ethylene glycol)ether tetra-amino] (4-armed
amino PEG, which includes structures having a linking group(s)
between an amino group(s) and the terminus of the polyethylene
glycol backbone) and pentaerythritol poly(ethylene glycol)ether
tetra-succinimidyl glutarate] (4-armed NHS PEG, which again
includes structures having a linking group(s) between a NHS
group(s) and the terminus of the polyethylene glycol backbone) as
reactive reagents. Chemical structures for these reactants are
shown in, e.g., U.S. Pat. No. 5,874,500. Optionally, collagen or a
collagen derivative (e.g., methylated collagen) is added to the
poly(ethylene glycol)-containing reactant(s) to form a preferred
crosslinked matrix that can serve as a polymeric carrier for a
therapeutic agent or a stand-alone composition to help prevent the
formation of fibrous or gliotic tissue around the CRM lead and
electrode.
[0168] It should be apparent to one of skill in the art that
potentially any anti-scarring agent described herein may be
utilized alone, or in combination, in the practice of this
embodiment. As CRM devices, leads and electrodes are made in a
variety of configurations and sizes, the exact dose administered
may vary with device size, surface area and design. However,
certain principles can be applied in the application of this art.
Drug dose can be calculated as a function of dose per unit area (of
the portion of the device being coated), total drug dose
administered can be measured, and appropriate surface
concentrations of active drug can be determined. Regardless of the
method of application of the drug to the device (i.e., as a coating
or infiltrated into the surrounding tissue), the
fibrosis-inhibiting agents, used alone or in combination, may be
administered under the following dosing guidelines:
[0169] Drugs and dosage: Exemplary therapeutic agents that may be
used include, but are not limited to: antimicrotubule agents
including taxanes (e.g., paclitaxel and docetaxel), other
microtubule stabilizing agents, mycophenolic acid, rapamycin and
vinca alkaloids (e.g., vinblastine and vincristine sulfate). Drugs
are to be used at concentrations that range from several times more
than a single systemic dose (e.g., the dose used in oral or i.v.
administration) to a fraction of a single systemic dose (e.g., 10%,
5%, or enven less than 1% of the conventration typically used in a
single systemic dose application). Preferably, the drug is released
in effective concentrations for a period ranging 1-90 days.
Antimicrotubule (e.g., doectaxel) thereof, and vinca alkaloids,
including vinblastine and vincristine sulfate and analogues and
derivatives thereof, should be used under the following parameters:
total dose not exceed 10 mg (range of 0.1 .mu.g to 10 mg);
preferred total dose 1 .mu.g to 3 mg. Dose per unit area of the
device of 0.1 .mu.g-10 .mu.g per mm.sup.2; preferred dose/unit area
of 0.25 .mu.g/mm.sup.2-5 .mu.g/mm.sup.2. Minimum concentration of
10.sup.-8-10.sup.-4 M of drug is to be maintained on the device
surface. Immunomodulators including sirolimus and everolimus.
Sirolimus (i.e., rapamycin, RAPAMUNE): Total dose not to exceed 10
mg (range of 0.1 .mu.g to 10 mg); preferred 10 .mu.g to 1 mg. The
dose per unit area of 0.1 .mu.g-100 .mu.g per mm.sup.2; preferred
dose of 0.5 .mu.g/mm.sup.2-10 .mu.g/mm.sup.2. Minimum concentration
of 10.sup.-8-10.sup.-4 M is to be maintained on the device surface.
Everolimus and derivatives and analogues thereof: Total dose should
not exceed 10 mg (range of 0.1 .mu.g to 10 mg); preferred 10 .mu.g
to 1 mg. The dose per unit area of 0.1 .mu.g-100 .mu.g per mm.sup.2
of surface area; preferred dose of 0.3 .mu.g/mm.sup.2-10
.mu.g/mm.sup.2. Minimum concentration of 10.sup.-8-10.sup.-4 M of
everolimus is to be maintained on the device surface. Inosine
monophosphate dehydrogenase inhibitors (e.g., mycophenolic acid,
1-alpha-25 dihydroxy vitamin D.sub.3) and analogues and derivatives
thereof: total dose not to exceed 2000 mg (range of 10.0 .mu.g to
2000 mg); preferred 10 .mu.g to 300 mg. The dose per unit area of
the device of 1.0 .mu.g-1000 .mu.g per mm.sup.2; preferred dose of
2.5 .mu.g/mm.sup.2-500 .mu.g/mm.sup.2. Minimum concentration of
10.sup.-8-10.sup.-3 M of mycophenolic acid is to be maintained on
the device surface.
[0170] B. Therapeutic Agents for Use with Electrical Medical
Devices and Implants
[0171] As described previously, numerous therapeutic agents are
potentially suitable to inhibit fibrous (or glial) tissue
accumulation around the device bodies, leads and electrodes of
implantable electrical devices, e.g., neurostimulation and cardiac
rhythm management devices. The invention provides for devices that
include an agent that inhibits this tissue accumulation in the
vicinity of the device, i.e., between the medical device and the
host into which the medical device is implanted. The agent is
therefore effective for this goal, is present in an amount that is
effective to achieve this goal, and is present at one or more
locations that allow for this goal to be achieved, and the device
is designed to allow the beneficial effects of the agent to occur.
Also, these therapeutic agents can be used alone, or in
combination, to prevent scar (or glial) tissue build-up in the
vicinity of the electrode-tissue interface in order to improve the
clinical performance and longevity of these implants.
[0172] Suitable fibrosis or gliosis-inhibiting agents may be
readily identified based upon in vitro and in vivo (animal) models,
such as those provided in Examples 38-51. Agents which inhibit
fibrosis can also be identified through in vivo models including
inhibition of intimal hyperplasia development in the rat balloon
carotid artery model (Examples 43 and 51). The assays set forth in
Examples 42 and 50 may be used to determine whether an agent is
able to inhibit cell proliferation in fibroblasts and/or smooth
muscle cells. In one aspect of the invention, the agent has an
IC.sub.50 for inhibition of cell proliferation within a range of
about 10.sup.-6 to about 10.sup.-10 M. The assay set forth in
Example 46 may be used to determine whether an agent may inhibit
migration of fibroblasts and/or smooth muscle cells. In one aspect
of the invention, the agent has an IC.sub.50 for inhibition of cell
migration within a range of about 10.sup.-6 to about 10.sup.-9M.
Assays set forth herein may be used to determine whether an agent
is able to inhibit inflammatory processes, including nitric oxide
production in macrophages (Example 38), and/or TNF-alpha production
by macrophages (Example 39), and/or IL-1 beta production by
macrophages (Example 47), and/or IL-8 production by macrophages
(Example 48), and/or inhibition of MCP-1 by macrophages (Example
49). In one aspect of the invention, the agent has an IC.sub.50 for
inhibition of any one of these inflammatory processes within a
range of about 10.sup.-6 to about 10.sup.-10M. The assay set forth
in Example 44 may be used to determine whether an agent is able to
inhibit MMP production. In one aspect of the invention, the agent
has an IC.sub.50 for inhibition of MMP production within a range of
about 10.sup.-4 to about 10.sup.-8M. The assay set forth in Example
45 (also known as the CAM assay) may be used to determine whether
an agent is able to inhibit angiogenesis. In one aspect of the
invention, the agent has an IC.sub.50 for inhibition of
angiogenesis within a range of about 10.sup.-6 to about
10.sup.-10M. Agents which reduce the formation of surgical
adhesions may be identified through in vivo models including the
rabbit surgical adhesions model (Example 41) and the rat caecal
sidewall model (Example 40). These pharmacologically active agents
(described below) can then be delivered at appropriate dosages
(described herein) into to the tissue either alone, or via carriers
(formulations are described herein), to treat the clinical problems
described previously herein. Numerous therapeutic compounds have
been identified that are of utility in the present invention
including:
[0173] 1) Angiogenesis Inhibitors
[0174] In one embodiment, the pharmacologically active compound is
an angiogenesis inhibitor (e.g., 2-ME (NSC-659853), PI-88
(D-mannose,
O-6-O-phosphono-alpha-D-mannopyranosyl-(1-3)-O-alpha-D-mannopyranosyl-(1--
3)-O-alpha-D-mannopyranosyl-(1-3)-O-alpha-D-mannopyranosyl-(1-2)-hydrogen
sulphate), thalidomide (1H-isoindole-1,3(2H)-dione,
2-(2,6-dioxo-3-piperidinyl)-), CDC-394, CC-5079, ENMD-0995
(S-3-amino-phthalidoglutarimide), AVE-8062A, vatalanib, SH-268,
halofuginone hydrobromide, atiprimod dimaleate
(2-azaspivo[4.5]decane-2-p- ropanamine, N,N-diethyl-8,8-dipropyl,
dimaleate), ATN-224, CHIR-258, combretastatin A-4 (phenol,
2-methoxy-5-[2-(3,4,5-trimethoxyphenyl)etheny- l]-, (Z)-),
GCS-100LE, or an analogue or derivative thereof).
[0175] 2) 5-Lipoxygenase Inhibitors and Antagonists
[0176] In another embodiment, the pharmacologically active compound
is a 5-lipoxygenase inhibitor or antagonist (e.g., Wy-50295
(2-naphthaleneacetic acid, alpha-methyl-6-(2-quinolinylmethoxy)-,
(S)-), ONO-LP-269 (2,11,14-eicosatrienamide,
N-(4-hydroxy-2-(1H-tetrazol-5-yl)-8- -quinolinyl)-, (E,Z,Z)-),
licofelone (1H-pyrrolizine-5-acetic acid,
6-(4-chlorophenyl)-2,3-dihydro-2,2-dimethyl-7-phenyl-), CMI-568
(urea,
N-butyl-N-hydroxy-N'-(4-(3-(methylsulfonyl)-2-propoxy-5-(tetrahydro-5-(3,-
4,5-trimethoxyphenyl)-2-furanyl)phenoxy)butyl)-,trans-), IP-751
((3R,4R)-(delta 6)-THC-DMH-11-oic acid), PF-5901 (benzenemethanol,
alpha-pentyl-3-(2-quinolinylmethoxy)-), LY-293111 (benzoic acid,
2-(3-(3-((5-ethyl-4'-fluoro-2-hydroxy(1,1'-biphenyl)-4-yl)oxy)propoxy)-2--
propylphenoxy)-), RG-5901-A (benzenemethanol,
alpha-pentyl-3-(2-quinolinyl- methoxy)-, hydrochloride), rilopirox
(2(1H )-pyridinone,
6-((4-(4-chlorophenoxy)phenoxy)methyl)-1-hydroxy-4-methyl-),
L-674636 (acetic acid,
((4-(4-chlorophenylyl-(4-(2-quinolinylmethoxy)phenyl)butyl)-
thio)-AS)),
7-((3-(4-methoxy-tetrahydro-2H-pyran-4-yl)phenyl)methoxy)-4-ph-
enylnaphtho(2,3-c)furan-1 (3H)-one, MK-886 (1H-indole-2-propanoic
acid, 1-((4-chlorophenyl)methyl)-3-((1,1-dimethylethyl)thio)-alpha,
alpha-dimethyl-5-(1-methylethyl)-), quiflapon
(1H-indole-2-propanoic acid,
1-((4-chlorophenyl)methyl)-3-((1,1-dimethylethyl)thio)-alpha,
alpha-dimethyl-5-(2-quinolinylmethoxy)-), quiflapon
(1H-Indole-2-propanoic acid,
1-((4-chlorophenyl)methyl)-3-((1,1-dimethyle- thyl)thio)-alpha,
alpha-dimethyl-5-(2-quinolinylmethoxy)-), docebenone
(2,5-cyclohexadiene-1,4-dione,
2-(12-hydroxy-5,10-dodecadiynyl)-3,5,6-tri- methyl-), zileuton
(urea, N-(1-benzo(b)thien-2-ylethyl)-N-hydroxy-), or an analogue or
derivative thereof).
[0177] 3) Chemokine Receptor Antagonists CCR (1, 3, and 5)
[0178] In another embodiment, the pharmacologically active compound
is a chemokine receptor antagonist which inhibits one or more
subtypes of CCR (1, 3, and 5) (e.g., ONO-4128
(1,4,9-triazaspiro(5.5)undecane-2,5-dione,
1-butyl-3-(cyclohexylmethyl)-9-((2,3-dihydro-1,4-benzodioxin-6-yl)methyl--
), L-381, CT-112 (L-arginine,
L-threonyl-L-threonyl-L-seryl-L-glutaminyl-L-
-valyl-L-arginyl-L-prolyl-), AS-900004, SCH-C, ZK-811752,
PD-172084, UK-427857, SB-380732, vMIP II, SB-265610, DPC-168,
TAK-779
(N,N-dimethyl-N-(4-(2-(4-methylphenyl)-6,7-dihydro-5H-benzocyclohepten-8--
ylcarboxamido)benyl)tetrahydro-2H-pyran-4-aminium chloride),
TAK-220, KRH-1120), GSK766994, SSR-150106, or an analogue or
derivative thereof). Other examples of chemokine receptor
antagonists include a-Immunokine-NNS03, BX-471, CCX-282,
Sch-350634; Sch-351125; Sch-417690; SCH-C, and analogues and
derivatives thereof.
[0179] 4) Cell Cycle Inhibitors
[0180] In another embodiment, the pharmacologically active compound
is a cell cycle inhibitor. Representative examples of such agents
include taxanes (e.g., paclitaxel (discussed in more detail below)
and docetaxel) (Schiff et al., Nature 277:665-667, 1979; Long and
Fairchild, Cancer Research 54:4355-4361, 1994; Ringel and Horwitz,
J. Nat'l Cancer Inst. 83(4):288-291, 1991; Pazdur et al., Cancer
Treat. Rev. 19(40):351-386, 1993), etanidazole, nimorazole (B. A.
Chabner and D. L. Longo. Cancer Chemotherapy and
Biotherapy--Principles and Practice. Lippincott-Raven Publishers,
New York, 1996, p.554), perfluorochemicals with hyperbaric oxygen,
transfusion, erythropoietin, BW12C, nicotinamide, hydralazine, BSO,
WR-2721, ludR, DUdR, etanidazole, WR-2721, BSO, mono-substituted
keto-aldehyde compounds (L. G. Egyud. Keto-aldehyde-amine addition
products and method of making same. U.S. Pat. No. 4,066,650, Jan.
3, 1978), nitroimidazole (K. C. Agrawal and M. Sakaguchi.
Nitroimidazole radiosensitizers for Hypoxic tumor cells and
compositions thereof. U.S. Pat. No. 4,462,992, Jul. 31, 1984),
5-substituted-4-nitroimidazoles (Adams et al., Int. J. Radiat.
Biol. Relat. Stud. Phys., Chem. Med. 40(2):153-61, 1981), SR-2508
(Brown et al., Int. J. Radiat. Oncol., Biol. Phys. 7(6):695-703,
1981), 2H-isoindolediones (J. A. Myers, 2H-Isoindolediones, the
synthesis and use as radiosensitizers. U.S. Pat. No. 4,494,547,
Jan. 22, 1985), chiral (((2-bromoethyl)-amino)methyl)-nitr-
o-1H-imidazole-1-ethanol (V. G. Beylin, et al., Process for
preparing chiral
(((2-bromoethyl)-amino)methyl)-nitro-1H-imidazole-1-ethanol and
related compounds. U.S. Pat. No. 5,543,527, Aug. 6, 1996; U.S. Pat.
No. 4,797,397; Jan. 10, 1989; U.S. Pat. No. 5,342,959, Aug. 30,
1994), nitroaniline derivatives (W. A. Denny, et al. Nitroaniline
derivatives and the use as anti-tumor agents. U.S. Pat. No.
5,571,845, Nov. 5, 1996), DNA-affinic hypoxia selective cytotoxins
(M. V. Papadopoulou-Rosenzweig. DNA-affinic hypoxia selective
cytotoxins. U.S. Pat. No. 5,602,142, Feb. 11, 1997), halogenated
DNA ligand (R. F. Martin. Halogenated DNA ligand radiosensitizers
for cancer therapy. U.S. Pat. No. 5,641,764, Jun. 24, 1997), 1,2,4
benzotriazine oxides (W. W. Lee et al. 1,2,4-benzotriazine oxides
as radiosensitizers and selective cytotoxic agents. U.S. Pat. No.
5,616,584, Apr. 1, 1997; U.S. Pat. No. 5,624,925, Apr. 29, 1997;
Process for Preparing 1,2,4 Benzotriazine oxides. U.S. Pat. No.
5,175,287, Dec. 29, 1992), nitric oxide (J. B. Mitchell et al., Use
of Nitric oxide releasing compounds as hypoxic cell radiation
sensitizers. U.S. Pat. No. 5,650,442, Jul. 22, 1997),
2-nitroimidazole derivatives (M. J. Suto et al. 2-Nitroimidazole
derivatives useful as radiosensitizers for hypoxic tumor cells.
U.S. Pat. No. 4,797,397, Jan. 10, 1989; T. Suzuki. 2-Nitroimidazole
derivative, production thereof, and radiosensitizer containing the
same as active ingredient. U.S. Pat. No. 5,270,330, Dec. 14, 1993;
T. Suzuki et al. 2-Nitroimidazole derivative, production thereof,
and radiosensitizer containing the same as active ingredient. U.S.
Pat. No. 5,270,330, Dec. 14, 1993; T. Suzuki. 2-Nitroimidazole
derivative, production thereof and radiosensitizer containing the
same as active ingredient; Patent EP 0 513 351 B1, Jan. 24, 1991),
fluorine-containing nitroazole derivatives (T. Kagiya.
Fluorine-containing nitroazole derivatives and radiosensitizer
comprising the same. U.S. Pat. No. 4,927,941, May 22, 1990), copper
(M. J. Abrams. Copper Radiosensitizers. U.S. Pat. No. 5,100,885,
Mar. 31, 1992), combination modality cancer therapy (D. H. Picker
et al. Combination modality cancer therapy. U.S. Pat. No.
4,681,091, Jul. 21, 1987). 5-CldC or (d)H.sub.4U or
5-halo-2'-halo-2'-deoxy-cytidine or -uridine derivatives (S. B.
Greer. Method and Materials for sensitizing neoplastic tissue to
radiation. U.S. Pat. No. 4,894,364 Jan. 16, 1990), platinum
complexes (K. A. Skov. Platinum Complexes with one radiosensitizing
ligand. U.S. Pat. No. 4,921,963. May 1, 1990; K. A. Skov. Platinum
Complexes with one radiosensitizing ligand. Patent EP 0 287 317
A3), fluorine-containing nitroazole (T. Kagiya, et al.
Fluorine-containing nitroazole derivatives and radiosensitizer
comprising the same. U.S. Pat. No. 4,927,941. May 22, 1990),
benzamide (W. W. Lee. Substituted Benzamide Radiosensitizers. U.S.
Pat. No. 5,032,617, Jul. 16, 1991), autobiotics (L. G. Egyud.
Autobiotics and the use in-eliminating nonself cells in vivo. U.S.
Pat. No. 5,147,652. Sep. 15, 1992), benzamide and nicotinamide (W.
W. Lee et al. Benzamide and Nictoinamide Radiosensitizers. U.S.
Pat. No. 5,215,738, Jun. 1 1993), acridine-intercalator (M.
Papadopoulou-Rosenzweig. Acridine Intercalator based hypoxia
selective cytotoxins. U.S. Pat. No. 5,294,715, Mar. 15, 1994),
fluorine-containing nitroimidazole (T. Kagiya et al. Fluorine
containing nitroimidazole compounds. U.S. Pat. No. 5,304,654, Apr.
19, 1994), hydroxylated texaphyrins (J. L. Sessler et al.
Hydroxylated texaphrins. U.S. Pat. No. 5,457,183, Oct. 10, 1995),
hydroxylated compound derivative (T. Suzuki et al. Heterocyclic
compound derivative, production thereof and radiosensitizer and
antiviral agent containing said derivative as active ingredient.
Publication Number 011106775 A (Japan), Oct. 22, 1987; T. Suzuki et
al. Heterocyclic compound derivative, production thereof and
radiosensitizer, antiviral agent and anti cancer agent containing
said derivative as active ingredient. Publication Number 01139596 A
(Japan), Nov. 25, 1987; S. Sakaguchi et al. Heterocyclic compound
derivative, its production and radiosensitizer containing said
derivative as active ingredient; Publication Number 63170375 A
(Japan), Jan. 7, 1987), fluorine containing 3-nitro-1,2,4-triazole
(T. Kagitani et al. Novel fluorine-containing
3-nitro-1,2,4-triazole and radiosensitizer containing same
compound. Publication Number 02076861 A (Japan), Mar. 31, 1988),
5-thiotretrazole derivative or its salt (E. Kano et al.
Radiosensitizer for Hypoxic cell. Publication Number 61010511 A
(Japan), Jun. 26, 1984), Nitrothiazole (T. Kagitani et al.
Radiation-sensitizing agent. Publication Number 61167616 A (Japan)
Jan. 22, 1985), imidazole derivatives (S. Inayma et al. Imidazole
derivative. Publication Number 6203767 A (Japan) Aug. 1, 1985;
Publication Number 62030768 A (Japan) Aug. 1, 1985; Publication
Number 62030777 A (Japan) Aug. 1, 1985), 4-nitro-1,2,3-triazole (T.
Kagitani et al. Radiosensitizer. Publication Number 62039525 A
(Japan), Aug. 15, 1985), 3-nitro-1,2,4-triazole (T. Kagitani et al.
Radiosensitizer. Publication Number 62138427 A (Japan), Dec. 12,
1985), Carcinostatic action regulator (H. Amagase. Carcinostatic
action regulator. Publication Number 63099017 A (Japan), Nov. 21,
1986), 4,5-dinitroimidazole derivative (S. Inayama.
4,5-Dinitroimidazole derivative. Publication Number 63310873 A
(Japan) Jun. 9, 1987), nitrotriazole Compound (T. Kagitanil
Nitrotriazole Compound. Publication Number 07149737 A (Japan) Jun.
22, 1993), cisplatin, doxorubin, misonidazole, mitomycin,
tiripazamine, nitrosourea, mercaptopurine, methotrexate,
fluorouracil, bleomycin, vincristine, carboplatin, epirubicin,
doxorubicin, cyclophosphamide, vindesine, etoposide (I. F. Tannock.
Review Article: Treatment of Cancer with Radiation and Drugs.
Journal of Clinical Oncology 14(12):3156-3174, 1996), camptothecin
(Ewend M. G. et al. Local delivery of chemotherapy and concurrent
external beam radiotherapy prolongs survival in metastatic brain
tumor models. Cancer Research 56(22):5217-5223, 1996) and
paclitaxel (Tishler R. B. et al. Taxol: a novel radiation
sensitizer. International Journal of Radiation Oncology and
Biological Physics 22(3):613-617, 1992).
[0181] A number of the above-mentioned cell cycle inhibitors also
have a wide variety of analogues and derivatives, including, but
not limited to, cisplatin, cyclophosphamide, misonidazole,
tiripazamine, nitrosourea, mercaptopurine, methotrexate,
fluorouracil, epirubicin, doxorubicin, vindesine and etoposide.
Analogues and derivatives include (CPA).sub.2Pt(DOLYM) and
(DACH)Pt(DOLYM) cisplatin (Choi et al., Arch. Pharmacal Res.
22(2):151-156, 1999), Cis-(PtCl.sub.2(4,7-H-5-methyl-7-oxo-
)1,2,4(triazolo(1,5-a)pyrimidine).sub.2) (Navarro et al., J. Med.
Chem. 41(3):332-338, 1998),
(Pt(cis-1,4-DACH)(trans-Cl.sub.2)(CBDCA)). 1/2MeOH cisplatin
(Shamsuddin et al., Inorg. Chem. 36(25):5969-5971, 1997),
4-pyridoxate diammine hydroxy platinum (Tokunaga et al., Pharm.
Sci. 3(7):353-356, 1997), Pt(II) . . . Pt(II)
(Pt.sub.2(NHCHN(C(CH.sub.2)(CH.s- ub.3))).sub.4) (Navarro et al.,
Inorg. Chem. 35(26):7829-7835, 1996), 254-S cisplatin analogue
(Koga et al., Neurol. Res. 18(3):244-247, 1996), o-phenylenediamine
ligand bearing cisplatin analogues (Koeckerbauer & Bednarski,
J. Inorg. Biochem. 62(4):281-298, 1996),
trans,cis-(Pt(OAc).sub.2I.sub.2(en)) (Kratochwil et al., J. Med.
Chem. 39(13):2499-2507, 1996), estrogenic 1,2-diarylethylenediamine
ligand (with sulfur-containing amino acids and glutathione) bearing
cisplatin analogues (Bednarski, J. Inorg. Biochem. 62(1):75, 1996),
cis-1,4-diaminocyclohexane cisplatin analogues (Shamsuddin et al.,
J. Inorg. Biochem. 61(4):291-301, 1996), 5' orientational isomer of
cis-(Pt(NH.sub.3)(4-amino TEMP-O){d(GpG)}) (Dunham & Lippard,
J. Am. Chem. Soc. 117(43):10702-12, 1995), chelating
diamine-bearing cisplatin analogues (Koeckerbauer & Bednarski,
J. Pharm. Sci. 84(7):819-23, 1995), 1,2-diarylethyleneamine
ligand-bearing cisplatin analogues (Otto et al., J. Cancer Res.
Clin. Oncol. 121(1):31-8, 1995), (ethylenediamine)platinum- (II)
complexes (Pasini et al., J. Chem. Soc., Dalton Trans. 4:579-85,
1995), CI-973 cisplatin analogue (Yang et al., Int. J. Oncol.
5(3):597-602, 1994), cis-diamminedichloroplatinum(II) and its
analogues cis-1,1-cyclobutanedicarbosylato(2
R)-2-methyl-1,4-butanediam-mineplatinu- m(II) and
cis-diammine(glycolato)platinum (Claycamp & Zimbrick, J. Inorg.
Biochem., 26(4):257-67, 1986; Fan et al., Cancer Res.
48(11):3135-9, 1988; Heiger-Bernays et al., Biochemistry
29(36):8461-6, 1990; Kikkawa et al., J. Exp. Clin. Cancer Res.
12(4):233-40, 1993; Murray et al., Biochemistry 31(47):11812-17,
1992; Takahashi et al., Cancer Chemother. Pharmacol. 33(1):31-5,
1993), cis-amine-cyclohexylamine-dichloroplatinum(- II) (Yoshida et
al., Biochem. Pharmacol. 48(4):793-9, 1994), gem-diphosphonate
cisplatin analogues (FR 2683529),
(meso-1,2-bis(2,6-dichloro-4-hydroxyplenyl)ethylenediamine)
dichloroplatinum(II) (Bednarski et al., J. Med. Chem.
35(23):4479-85, 1992), cisplatin analogues containing a tethered
dansyl group (Hartwig et al., J. Am. Chem. Soc. 114(21):8292-3,
1992), platinum(II) polyamines (Siegmann et al., Inorg.
Met.-Containing Polym. Mater., (Proc. Am. Chem. Soc. Int. Symp.),
335-61, 1990), cis-(3H)dichloro(ethylenediamine)platinu- m(II)
(Eastman, Anal. Biochem. 197(2):311-15, 1991),
trans-diamminedichloroplatinum(II) and
cis-(Pt(NH.sub.3).sub.2(N.sub.3-cy- tosine)Cl) (Bellon &
Lippard, Biophys. Chem. 35(2-3):179-88, 1990), 3H-cis-1,2-d
iaminocyclohexanedichloroplatinum(II) and
3H-cis-1,2-diaminocyclohexane-malonatoplatinum(II) (Oswald et al.,
Res. Commun. Chem. Pathol. Pharmacol. 64(1):41-58, 1989),
diaminocarboxylatoplatinum (EPA 296321),
trans-(D,1)-1,2-diaminocyclohexa- ne carrier ligand-bearing
platinum analogues (Wyrick & Chaney, J. Labelled Compd.
Radiopharm. 25(4):349-57, 1988), aminoalkylaminoanthraquinone-deri-
ved cisplatin analogues (Kitov et al., Eur. J. Med. Chem.
23(4):381-3, 1988), spiroplatin, carboplatin, iproplatin and JM40
platinum analogues (Schroyen et al., Eur. J. Cancer Clin. Oncol.
24(8):1309-12, 1988), bidentate tertiary diamine-containing
cisplatinum derivatives (Orbell et al., Inorg. Chim. Acta
152(2):125-34, 1988), platinum(II), platinum(IV) (Liu & Wang,
Shandong Yike Daxue Xuebao 24(1):35-41, 1986),
cis-diammine(1,1-cyclobutanedicarboxylato-)platinum(II)
(carboplatin, JM8) and ethylenediammine-malonatoplatinum(II) (JM40)
(Begg et al., Radiother. Oncol. 9(2):157-65, 1987), JM8 and JM9
cisplatin analogues (Harstrick et al., Int. J. Androl. 10(1);
139-45, 1987), (NPr4)2((PtCL4).cis-(PtCl2-(NH2Me)2)) (Brammer et
al., J. Chem. Soc., Chem. Commun. 6:443-5, 1987), aliphatic
tricarboxylic acid platinum complexes (EPA 185225),
cis-dichloro(amino acid)(tert-butylamine)platinum- (II) complexes
(Pasini & Bersanetti, Inorg. Chim. Acta 107(4):259-67, 1985);
4-hydroperoxycylcophosphamide (Ballard et al., Cancer Chemother.
Pharmacol. 26(6):397-402, 1990), acyclouridine cyclophosphamide
derivatives (Zakerinia et al., Helv. Chim. Acta 73(4):912-15,
1990), 1,3,2-dioxa- and -oxazaphosphorinane cyclophosphamide
analogues (Yang et al., Tetrahedron 44(20):6305-14, 1988),
C5-substituted cyclophosphamide analogues (Spada, University of
Rhode Island Dissertation, 1987), tetrahydrooxazine
cyclophosphamide analogues (Valente, University of Rochester
Dissertation, 1988), phenyl ketone cyclophosphamide analogues
(Hales et al., Teratology 39(1):31-7, 1989), phenylketophosphamide
cyclophosphamide analogues (Ludeman et al., J. Med. Chem.
29(5):716-27, 1986), ASTA Z-7557 cyclophosphamide analogues (Evans
et al., Int. J. Cancer 34(6):883-90, 1984),
3-(1-oxy-2,2,6,6-tetramethyl-4-piperidinyl)cy- clophosphamide (Tsui
et al., J. Med. Chem. 25(9):1106-10, 1982),
2-oxobis(2-.beta.-chloroethylamino)-4-,6-dimethyl-1,3,2-oxazaphosphorinan-
e cyclophosphamide (Carpenter et al., Phosphorus Sulfur
12(3):287-93, 1982), 5-fluoro- and 5-chlorocyclophosphamide
(Fosteret al., J. Med. Chem. 24(12):1399-403, 1981), cis- and
trans-4-phenylcyclophosphamide (Boyd et al., J. Med. Chem.
23(4):372-5, 1980), 5-bromocyclophosphamide,
3,5-dehydrocyclophosphamide (Ludeman et al., J. Med. Chem.
22(2):151-8, 1979), 4-ethoxycarbonyl cyclophosphamide analogues
(Foster, J. Pharm. Sci. 67(5):709-10, 1978),
arylaminotetrahydro-2H-1,3,2-oxazaphosphorine 2-oxide
cyclophosphamide analogues (Hamacher, Arch. Pharm. (Weinheim, Ger.)
310(5):J,428-34, 1977), NSC-26271 cyclophosphamide analogues
(Montgomery & Struck, Cancer Treat. Rep. 60(4):J381-93, 1976),
benzo annulated cyclophosphamide analogues (Ludeman & Zon, J.
Med. Chem. 18(12):J1251-3, 1975), 6-trifluoromethylcyclophosphamide
(Farmer & Cox, J. Med. Chem. 18(11):J1106-10, 1975),
4-methylcyclophosphamide and 6-methycyclophosphamide analogues (Cox
et al., Biochem. Pharmacol. 24(5):J599-606, 1975); FCE 23762
doxorubicin derivative (Quaglia et al., J. Liq. Chromatogr.
17(18):3911-3923, 1994), annamycin (Zou et al., J. Pharm. Sci.
82(11):1151-1154, 1993), ruboxyl (Rapoport et al., J. Controlled
Release 58(2):153-162, 1999), anthracycline disaccharide
doxorubicin analogue (Pratesi et al., Clin. Cancer Res.
4(11):2833-2839, 1998), N-(trifluoroacetyl)doxorubicin and
4'-O-acetyl-N-(trifluoroacetyl)- doxorubicin (Berube & Lepage,
Synth. Commun. 28(6):1109-1116, 1998), 2-pyrrolinodoxorubicin (Nagy
et al., Proc. Nat'l Acad. Sci. U.S.A. 95(4):1794-1799, 1998),
disaccharide doxorubicin analogues (Arcamone et al., J. Nat'l
Cancer Inst. 89(16):1217-1223, 1997),
4-demethoxy-7-O-(2,6-dideoxy-4-O-(2,3,6-trideoxy-3-amino-.alpha.-L-lyxo-h-
exopyranosyl)-.alpha.-L-lyxo-hexopyranosyl)-adriamicinone
doxorubicin disaccharide analogue (Monteagudo et al., Carbohydr.
Res. 300(1):11-16, 1997), 2-pyrrolinodoxorubicin (Nagy et al.,
Proc. Nat'l Acad. Sci. U.S.A. 94(2):652-656, 1997), morpholinyl
doxorubicin analogues (Duran et al., Cancer Chemother. Pharmacol.
38(3):210-216, 1996), enaminomalonyl-.beta.-alanine doxorubicin
derivatives (Seitz et al., Tetrahedron Lett. 36(9):1413-16, 1995),
cephalosporin doxorubicin derivatives (Vrudhula et al., J. Med.
Chem. 38(8):1380-5, 1995), hydroxyrubicin (Solary et al., Int. J.
Cancer 58(1):85-94, 1994), methoxymorpholino doxorubicin derivative
(Kuhl et al., Cancer Chemother. Pharmacol. 33(1):10-16, 1993),
(6-maleimidocaproyl)hydrazone doxorubicin derivative (Willner et
al., Bioconjugate Chem. 4(6):521-7, 1993),
N-(5,5-diacetoxypent-1-yl) doxorubicin (Cherif & Farquhar, J.
Med. Chem. 35(17):3208-14, 1992), FCE 23762 methoxymorpholinyl
doxorubicin derivative (Ripamonti et al., Br. J. Cancer
65(5):703-7, 1992), N-hydroxysuccinimide ester doxorubicin
derivatives (Demant et al., Biochim. Biophys. Acta 1118(1):83-90,
1991), polydeoxynucleotide doxorubicin derivatives (Ruggiero et
al., Biochim. Biophys. Acta 1129(3):294-302, 1991), morpholinyl
doxorubicin derivatives (EPA 434960), mitoxantrone doxorubicin
analogue (Krapcho et al., J. Med. Chem. 34(8):2373-80. 1991), AD198
doxorubicin analogue (Traganos et al., Cancer Res. 51(14):3682-9,
1991), 4-demethoxy-3'-N-trifluoroacetyldoxorubicin (Horton et al.,
Drug Des. Delivery 6(2):123-9, 1990), 4'-epidoxorubicin (Drzewoski
et al., Pol. J. Pharmacol. Pharm. 40(2):159-65, 1988; Weenen et
al., Eur. J. Cancer Clin. Oncol. 20(7):919-26, 1984), alkylating
cyanomorpholino doxorubicin derivative (Scudder et al., J. Nat'l
Cancer Inst. 80(16):1294-8, 1988), deoxydihydroiodooxorubicin (EPA
275966), adriblastin (Kalishevskaya et al., Vestn. Mosk. Univ.,
16(Biol. 1):21-7, 1988), 4'-deoxydoxorubicin (Schoelzel et al.,
Leuk. Res. 10(12):1455-9, 1986),
4-demethyoxy-4'-o-methyidoxorubicin (Giuliani et al., Proc. Int.
Congr. Chemother. 16:285-70-285-77, 1983),
3'-deamino-3'-hydroxydoxorubic- in (Horton et al., J. Antibiot.
37(8):853-8, 1984), 4-demethyoxy doxorubicin analogues (Barbieri et
al., Drugs Exp. Clin. Res. 10(2):85-90, 1984), N-L-leucyl
doxorubicin derivatives (Trouet et al., Anthracyclines (Proc. Int.
Symp. Tumor Pharmacother.), 179-81, 1983),
3'-deamino-3'-(4-methoxy-1-piperidinyl)doxorubicin derivatives
(U.S. Pat. No. 4,314,054), 3'-deamino-3'-(4-mortholinyl)doxorubicin
derivatives (U.S. Pat. No. 4,301,277), 4'-deoxydoxorubicin and
4'-o-methyldoxorubicin (Giuliani et al., Int. J. Cancer 27(1):5-13,
1981), aglycone doxorubicin derivatives (Chan & Watson, J.
Pharm. Sci. 67(12):1748-52, 1978), SM 5887 (Pharma Japan 1468:20,
1995), MX-2 (Pharma Japan 1420:19, 1994),
4'-deoxy-13(S)-dihydro-4'-iododoxorubicin (EP 275966), morpholinyl
doxorubicin derivatives (EPA 434960),
3'-deamino-3'-(4-methoxy-1-piperidi- nyl)doxorubicin derivatives
(U.S. Pat. No. 4,314,054), doxorubicin-14-valerate,
morpholinodoxorubicin (U.S. Pat. No. 5,004,606),
3'-deamino-3'-(3"-cyano-4"-morpholinyl doxorubicin;
3'-deamino-3'-(3"-cyano-4"-morpholinyl)-13-dihydoxorubicin;
(3'-deamino-3'-(3.varies.-cyano-4"-morpholinyl)daunorubicin;
3'-deamino-3'-(3"-cyano-4"-morpholinyl)-3-dihydrodaunorubicin; and
3'-deamino-3'-(4"-morpholinyl-5-iminodoxorubicin and derivatives
(U.S. Pat. No. 4,585,859),
3'-deamino-3'-(4-methoxy-1-piperidinyl)doxorubicin derivatives
(U.S. Pat. No. 4,314,054) and 3-deamino-3-(4-morpholinyl)doxo-
rubicin derivatives (U.S. Pat. No. 4,301,277);
4,5-dimethylmisonidazole (Born et al., Biochem. Pharmacol.
43(6):1337-44, 1992), azo and azoxy misonidazole derivatives
(Gattavecchia & Tonelli, Int J. Radiat. Biol. Relat. Stud.
Phys., Chem. Med. 45(5):469-77, 1984); RB90740 (Wardman et al., Br.
J. Cancer, 74 Suppl. (27):S70-S74, 1996); 6-bromo and
6-chloro-2,3-dihydro-1,4-benzothiazines nitrosourea derivatives
(Rai et al., Heterocycl. Commun. 2(6):587-592, 1996), diamino acid
nitrosourea derivatives (Dulude et al., Bioorg. Med. Chem. Lett.
4(22):2697-700, 1994; Dulude et al., Bioorg. Med. Chem.
3(2):151-60, 1995), amino acid nitrosourea derivatives (Zheleva et
al., Pharmazie 50(1):25-6, 1995),
3',4'-didemethoxy-3',4'-dioxo-4-deoxypodophyllotoxin nitrosourea
derivatives (Miyahara et al., Heterocycles 39(1):361-9, 1994), ACNU
(Matsunaga et al., Immunopharmacology 23(3):199-204, 1992),
tertiary phosphine oxide nitrosourea derivatives (Guguva et al.,
Pharmazie 46(8):603, 1991), sulfamerizine and sulfamethizole
nitrosourea derivatives (Chiang et al., Zhonghua Yaozue Zazhi
43(5):401-6, 1991), thymidine nitrosourea analogues (Zhang et al.,
Cancer Commun. 3(4):119-26, 1991),
1,3-bis(2-chloroethyl)-1-nitrosourea (August et al., Cancer Res.
51(6):1586-90, 1991), 2,2,6,6-tetramethyl-1-oxopiperidiunium
nitrosourea derivatives (U.S.S.R. 1261253), 2- and 4-deoxy sugar
nitrosourea derivatives (U.S. Pat. No. 4,902,791), nitroxyl
nitrosourea derivatives (U.S.S.R. 1336489), fotemustine (Boutin et
al., Eur. J. Cancer Clin. Oncol. 25(9):1311-16, 1989),
pyrimidine(II) nitrosourea derivatives (Wei et al., Chung-hua Yao
Hsueh Tsa Chih 41(1):19-26, 1989), CGP 6809 (Schieweck et al.,
Cancer Chemother. Pharmacol. 23(6):341-7, 1989), B-3839 (Prajda et
al., In Vivo 2(2):151-4, 1988), 5-halogenocytosine nitrosourea
derivatives (Chiang & Tseng, T'ai-wan Yao Hsueh Tsa Chih
38(1):37-43, 1986), 1-(2-chloroethyl)-3-isobutyl-3-(.beta.-
-maltosyl)-1-nitrosourea (Fujimoto & Ogawa, J. Pharmacobio-Dyn.
10(7):341-5, 1987), sulfur-containing nitrosoureas (Tang et al.,
Yaoxue Xuebao 21(7):502-9, 1986), sucrose,
6-((((2-chloroethyl)nitrosoamino-)car- bonyl)amino)-6-deoxysucrose
(NS-1C) and 6'-((((2-chloroethyl)nitrosoamino)-
carbonyl)amino)-6'-deoxysucrose (NS-1D) nitrosourea derivatives
(Tanoh et al., Chemotherapy (Tokyo) 33(11):969-77, 1985), CNCC,
RFCNU and chlorozotocin (Mena et al., Chemotherapy (Basel)
32(2):131-7, 1986), CNUA (Edanami et al., Chemotherapy (Tokyo)
33(5):455-61,
1985),1-(2-chloroethyl)-3-isobutyl-3-(.beta.-maltosyl)-1-nitrosourea
(Fujimoto & Ogawa, Jpn. J. Cancer Res. (Gann) 76(7):651-6,
1985), choline-like nitrosoalkylureas (Belyaev et al., Izv. Akad.
NAUK SSSR, Ser. Khim. 3:553-7, 1985), sucrose nitrosourea
derivatives (JP 84219300), sulfa drug nitrosourea analogues (Chiang
et al., Proc. Nat'l Sci. Counc., Repub. China, Part A 8(1):18-22,
1984), DONU (Asanuma et al., J. Jpn. Soc. Cancer Ther.
17(8):2035-43, 1982), N,N'-bis (N-(2-chloroethyl)-N-nit-
rosocarbamoyl)cystamine (CNCC) (Blazsek et al., Toxicol. Appl.
Pharmacol. 74(2):250-7, 1984), dimethylnitrosourea (Krutova et al.,
Izv. Akad. NAUK SSSR, Ser. Biol. 3:439-45, 1984), GANU (Sava &
Giraldi, Cancer Chemother. Pharmacol. 10(3):167-9, 1983), CCNU
(Capelli et al., Med., Biol., Environ. 11(1):111-16, 1983),
5-aminomethyl-2'-deoxyuridine nitrosourea analogues (Shiau, Shih Ta
Hsueh Pao (Taipei) 27:681-9, 1982), TA-077 (Fujimoto & Ogawa,
Cancer Chemother. Pharmacol. 9(3):134-9, 1982), gentianose
nitrosourea derivatives (JP 82 80396), CNCC, RFCNU, RPCNU AND
chlorozotocin (CZT) (Marzin et al., INSERM Symp., 19(Nitrosoureas
Cancer Treat.):165-74, 1981), thiocolchicine nitrosourea analogues
(George, Shih Ta Hsueh Pao (Taipei) 25:355-62, 1980),
2-chloroethyl-nitrosourea (Zeller & Eisenbrand, Oncology
38(1):39-42, 1981), ACNU, (1-(4-amino-2-methyl-5-p-
yrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride)
(Shibuya et al., Gan To Kagaku Ryoho 7(8):1393-401, 1980),
N-deacetylmethyl thiocolchicine nitrosourea analogues (Lin et al.,
J. Med. Chem. 23(12):1440-2, 1980), pyridine and piperidine
nitrosourea derivatives (Crider et al., J. Med. Chem. 23(8):848-51,
1980), methyl-CCNU (Zimber & Perk, Refu. Vet. 35(1):28, 1978),
phensuzimide nitrosourea derivatives (Crider et al., J. Med. Chem.
23(3):324-6, 1980), ergoline nitrosourea derivatives (Crider et
al., J. Med. Chem. 22(1):32-5, 1979), glucopyranose nitrosourea
derivatives (JP 78 95917),
1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (Farmer et al., J.
Med. Chem. 21(6):514-20, 1978),
4-(3-(2-chloroethyl)-3-nitrosoureid-o)-cis-cyc- lohexanecarboxylic
acid (Drewinko et al., Cancer Treat. Rep. 61(8):J 1513-18, 1977),
RPCNU (ICIG 1163) (Larnicol et al., Biomedicine 26(3):J176-81,
1977), IOB-252 (Sorodoc et al., Rev. Roum. Med., Virol. 28(1):J
55-61, 1977), 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) (Siebert
& Eisenbrand, Mutat. Res. 42(1):J45-50, 1977),
1-tetrahydroxycyclopentyl-3-nitroso-3-(2-chloroethyl)-urea (U.S.
Pat. No. 4,039,578),
d-1-1-(.beta.-chloroethyl)-3-(2-oxo-3-hexahydroazepinyl)-1-ni-
trosourea (U.S. Pat. No. 3,859,277) and gentianose nitrosourea
derivatives (JP 57080396); 6-S-aminoacyloxymethyl mercaptopurine
derivatives (Harada et al., Chem. Pharm. Bull. 43(10):793-6, 1995),
6-mercaptopurine (6-MP) (Kashida et al., Biol. Pharm. Bull.
18(11):1492-7, 1995),
7,8-polymethyleneimidazo-1,3,2-diazaphosphorines (Nilov et al.,
Mendeleev Commun. 2:67, 1995), azathioprine (Chifotides et al., J.
Inorg. Biochem. 56(4):249-64, 1994), methyl-D-glucopyranoside
mercaptopurine derivatives (Da Silva et al., Eur. J. Med. Chem.
29(2):149-52, 1994) and s-alkynyl mercaptopurine derivatives
(Ratsino et al., Khim.-Farm. Zh. 15(8):65-7, 1981); indoline ring
and a modified ornithine or glutamic acid-bearing methotrexate
derivatives (Matsuoka et al., Chem. Pharm. Bull. 45(7):1146-1150,
1997), alkyl-substituted benzene ring C bearing methotrexate
derivatives (Matsuoka et al., Chem. Pharm. Bull. 44(12):2287-2293,
1996), benzoxazine or benzothiazine moiety-bearing methotrexate
derivatives (Matsuoka et al., J. Med. Chem. 40(1):105-111, 1997),
10-deazaaminopterin analogues (DeGraw et al., J. Med. Chem.
40(3):370-376, 1997), 5-deazaaminopterin and
5,10-dideazaaminopterin methotrexate analogues (Piper et al., J.
Med. Chem. 40(3):377-384, 1997), indoline moiety-bearing
methotrexate derivatives (Matsuoka et al., Chem.
Pharm. Bull. 44(7):1332-1337, 1996), lipophilic amide methotrexate
derivatives (Pignatello et al., World Meet. Pharm., Biopharm.
Pharm. Technol., 563-4, 1995), L-threo-(2S, 4S)-4-fluoroglutamic
acid and DL-3,3-difluoroglutamic acid-containing methotrexate
analogues (Hart et al., J. Med. Chem. 39(1):56-65, 1996),
methotrexate tetrahydroquinazoline analogue (Gangjee, et al., J.
Heterocycl. Chem. 32(1):243-8, 1995),
N-(.alpha.-aminoacyl)methotrexate derivatives (Cheung et al.,
Pteridines 3(1-2):101-2, 1992), biotin methotrexate derivatives
(Fan et al., Pteridines 3(1-2):131-2, 1992), D-glutamic acid or
D-erythrou, threo-4-fluoroglutamic acid methotrexate analogues
(McGuire et al., Biochem. Pharmacol. 42(12):2400-3, 1991),
.beta.,.gamma.-methano methotrexate analogues (Rosowsky et al.,
Pteridines 2(3):133-9, 1991), 10-deazaaminopterin (10-EDAM)
analogue (Braakhuis et al., Chem. Biol. Pteridines, Proc. Int.
Symp. Pteridines Folic Acid Deriv., 1027-30, 1989),
.gamma.-tetrazole methotrexate analogue (Kalman et al., Chem. Biol.
Pteridines, Proc. Int. Symp. Pteridines Folic Acid Deriv., 1154-7,
1989), N-(L-.alpha.-aminoacyl)methotrexate derivatives (Cheung et
al., Heterocycles 28(2):751-8, 1989), meta and ortho isomers of
aminopterin (Rosowsky et al., J. Med. Chem. 32(12):2582, 1989),
hydroxymethylmethotrexate (DE 267495), .gamma.-fluoromethotrexate
(McGuire et al., Cancer Res. 49(16):4517-25, 1989), polyglutamyl
methotrexate derivatives (Kumar et al., Cancer Res. 46(10):5020-3,
1986), gem-diphosphonate methotrexate analogues (WO 88/06158),
.alpha.- and .gamma.-substituted methotrexate analogues (Tsushima
et al., Tetrahedron 44(17):5375-87, 1988), 5-methyl-5-deaza
methotrexate analogues (U.S. Pat. No. 4,725,687),
N.delta.-acyl-N.alpha.-(4-amino-4-deoxypteroyl)-L-ornithi- ne
derivatives (Rosowsky et al., J. Med. Chem. 31(7):1332-7, 1988),
8-deaza methotrexate analogues (Kuehl et al., Cancer Res.
48(6):1481-8, 1988), acivicin methotrexate analogue (Rosowsky et
al., J. Med. Chem. 30(8):1463-9, 1987), polymeric platinol
methotrexate derivative (Carraher et al., Polym. Sci. Technol.
(Plenum), 35(Adv. Biomed. Polym.):311-24, 1987),
methotrexate-.gamma.-dimyristoylphophatidylethanolamine (Kinsky et
al., Biochim. Biophys. Acta 917(2):211-18, 1987), methotrexate
polyglutamate analogues (Rosowsky et al., Chem. Biol. Pteridines,
Pteridines Folic Acid Deriv., Proc. Int. Symp. Pteridines Folic
Acid Deriv.: Chem., Biol. Clin. Aspects: 985-8, 1986),
poly-.gamma.-glutamyl methotrexate derivatives (Kisliuk et al.,
Chem. Biol. Pteridines, Pteridines Folic Acid Deriv., Proc. Int.
Symp. Pteridines Folic Acid Deriv.: Chem., Biol. Clin. Aspects:
989-92, 1986), deoxyuridylate methotrexate derivatives (Webber et
al., Chem. Biol. Pteridines, Pteridines Folic Acid Deriv., Proc.
Int. Symp. Pteridines Folic Acid Deriv.: Chem., Biol. Clin.
Aspects: 659-62, 1986), iodoacetyl lysine methotrexate analogue
(Delcamp et al., Chem. Biol. Pteridines, Pteridines Folic Acid
Deriv., Proc. Int. Symp. Pteridines Folic Acid Deriv.: Chem., Biol.
Clin. Aspects: 807-9, 1986), 2,.omega.-diaminoalkanoid
acid-containing methotrexate analogues (McGuire et al., Biochem.
Pharmacol. 35(15):2607-13, 1986), polyglutamate methotrexate
derivatives (Kamen & Winick, Methods Enzymol. 122 (Vitam.
Coenzymes, Pt. G):339-46, 1986), 5-methyl-5-deaza analogues (Piper
et al., J. Med. Chem. 29(6):1080-7, 1986), quinazoline methotrexate
analogue (Mastropaolo et al., J. Med. Chem. 29(1):155-8, 1986),
pyrazine methotrexate analogue (Lever & Vestal, J. Heterocycl.
Chem. 22(1):5-6, 1985), cysteic acid and homocysteic acid
methotrexate analogues (U.S. Pat. No. 4,490,529),
.gamma.-tert-butyl methotrexate esters (Rosowsky et al., J. Med.
Chem. 28(5):660-7, 1985), fluorinated methotrexate analogues
(Tsushima et al., Heterocycles 23(1):45-9, 1985), folate
methotrexate analogue (Trombe, J. Bacteriol. 160(3):849-53, 1984),
phosphonoglutamic acid analogues (Sturtz & Guillamot, Eur. J.
Med. Chem.--Chim. Ther. 19(3):267-73, 1984), poly
(L-lysine)methotrexate conjugates (Rosowsky et al., J. Med. Chem.
27(7):888-93, 1984), dilysine and trilysine methotrexate derivates
(Forsch & Rosowsky, J. Org. Chem. 49(7):1305-9, 1984),
7-hydroxymethotrexate (Fabre et al., Cancer Res. 43(10):4648-52,
1983), poly-.gamma.-glutamyl-methotrexate analogues (Piper &
Montgomery, Adv. Exp. Med. Biol., 163(Folyl Antifolyl
Polyglutamates):95-100, 1983), 3',5'-dichloromethotrexate (Rosowsky
& Yu, J. Med. Chem. 26(10):1448-52, 1983), diazoketone and
chloromethylketone methotrexate analogues (Gangjee et al., J.
Pharm. Sci. 71(6):717-19, 1982), 10-propargylaminopterin and alkyl
methotrexate homologs (Piper et al., J. Med. Chem. 25(7):877-80,
1982), lectin derivatives of methotrexate (Lin et al., JNCI
66(3):523-8, 1981), polyglutamate methotrexate derivatives
(Galivan, Mol. Pharmacol. 17(1):105-10, 1980), halogentated
methotrexate derivatives (Fox, JNCI 58(4):J955-8, 1977),
8-alkyl-7,8-dihydro analogues (Chaykovsky et al., J. Med. Chem.
20(10):J1323-7, 1977), 7-methyl methotrexate derivatives and
dichloromethotrexate (Rosowsky & Chen, J. Med. Chem.
17(12):J1308-11, 1974), lipophilic methotrexate derivatives and
3',5'-dichloromethotrexate (Rosowsky, J. Med. Chem. 16(10):J1190-3,
1973), deaza amethopterin analogues (Montgomery et al., Ann. N.Y.
Acad. Sci. 186:J227-34, 1971), MX068 (Pharma Japan, 1658:18, 1999)
and cysteic acid and homocysteic acid methotrexate analogues (EPA
0142220); N3-alkylated analogues of 5-fluorouracil (Kozai et al.,
J. Chem. Soc., Perkin Trans. 1(19):3145-3146, 1998), 5-fluorouracil
derivatives with 1,4-oxaheteroepane moieties (Gomez et al.,
Tetrahedron 54(43):13295-13312, 1998), 5-fluorouracil and
nucleoside analogues (Li, Anticancer Res. 17(1A):21-27, 1997), cis-
and trans-5-fluoro-5,6-dihydro-- 6-alkoxyuracil (Van der Wilt et
al., Br. J. Cancer 68(4):702-7, 1993), cyclopentane 5-fluorouracil
analogues (Hronowski & Szarek, Can. J. Chem. 70(4):1162-9,
1992), A-OT-fluorouracil (Zhang et al., Zongguo Yiyao Gongye Zazhi
20(11):513-15, 1989), N4-trimethoxybenzoyl-5'-deoxy-5-fluoro-
cytidine and 5'-deoxy-5-fluorouridine (Miwa et al., Chem. Pharm.
Bull. 38(4):998-1003, 1990), 1-hexylcarbamoyl-5-fluorouracil (Hoshi
et al., J. Pharmacobio-Dun. 3(9):478-81, 1980; Maehara et al.,
Chemotherapy (Basel) 34(6):484-9, 1988), B-3839 (Prajda et al., In
Vivo 2(2):151-4, 1988), uracil-1-(2-tetrahydrofuryl)-5-fluorouracil
(Anai et al., Oncology 45(3):144-7, 1988),
1-(2'-deoxy-2'-fluoro-.beta.-D-arabinofuranosyl)-5-fl- uorouracil
(Suzuko et al., Mol. Pharmacol. 31(3):301-6, 1987), doxifluridine
(Matuura et al., Oyo Yakuri 29(5):803-31, 1985),
5'-deoxy-5-fluorouridine (Bollag & Hartmann, Eur. J. Cancer
16(4):427-32, 1980), 1-acetyl-3-O-toluyl-5-fluorouracil (Okada,
Hiroshima J. Med. Sci. 28(1):49-66, 1979),
5-fluorouracil-m-formylbenzene-sulfonate (JP 55059173),
N'-(2-furanidyl)-5-fluorouracil (JP 53149985) and
1-(2-tetrahydrofuryl)-5-fluorouracil (JP 52089680);
4'-epidoxorubicin (Lanius, Adv. Chemother. Gastrointest. Cancer,
(Int. Symp.), 159-67, 1984); N-substituted deacetylvinblastine
amide (vindesine) sulfates (Conrad et al., J. Med. Chem.
22(4):391-400, 1979); and Cu(II)-VP-16 (etoposide) complex (Tawa et
al., Bioorg. Med. Chem. 6(7):1003-1008, 1998),
pyrrolecarboxamidino-bearing etoposide analogues (Ji et al.,
Bioorg. Med. Chem. Lett. 7(5):607-612, 1997), 4.beta.-amino
etoposide analogues (Hu, University of North Carolina Dissertation,
1992), .gamma.-lactone ring-modified arylamino etoposide analogues
(Zhou et al., J. Med. Chem. 37(2):287-92, 1994), N-glucosyl
etoposide analogue (Allevi et al., Tetrahedron Lett.
34(45):7313-16, 1993), etoposide A-ring analogues (Kadow et al.,
Bioorg. Med. Chem. Lett. 2(1):17-22, 1992), 4'-deshydroxy-4'-methyl
etoposide (Saulnier et al., Bioorg. Med. Chem. Lett. 2(10):1213-18,
1992), pendulum ring etoposide analogues (Sinha et al., Eur. J.
Cancer 26(5):590-3, 1990) and E-ring desoxy etoposide analogues
(Saulnier et al., J. Med. Chem. 32(7):1418-20, 1989).
[0182] Within one preferred embodiment of the invention, the cell
cycle inhibitor is paclitaxel, a compound which disrupts mitosis
(M-phase) by binding to tubulin to form abnormal mitotic spindles
or an analogue or derivative thereof. Briefly, paclitaxel is a
highly derivatized diterpenoid (Wani et al., J. Am. Chem. Soc.
93:2325, 1971) which has been obtained from the harvested and dried
bark of Taxus brevifolia (Pacific Yew) and Taxomyces Andreanae and
Endophytic Fungus of the Pacific Yew (Stierle et al., Science
60:214-216, 1993). "Paclitaxel" (which should be understood herein
to include formulations, prodrugs, analogues and derivatives such
as, for example, TAXOL (Bristol Myers Squibb, New York, N.Y.,
TAXOTERE (Aventis Pharmaceuticals, France), docetaxel, 10-desacetyl
analogues of paclitaxel and 3'N-desbenzoyl-3'N-t-butoxy carbonyl
analogues of paclitaxel) may be readily prepared utilizing
techniques known to those skilled in the art (see, e.g., Schiff et
al., Nature 277:665-667, 1979; Long and Fairchild, Cancer Research
54:4355-4361, 1994; Ringel and Horwitz, J. Nat'l Cancer Inst.
83(4):288-291, 1991; Pazdur et al., Cancer Treat. Rev.
19(4):351-386, 1993; WO 94/07882; WO 94/07881; WO 94/07880; WO
94/07876; WO 93/23555; WO 93/10076; WO94/00156; WO 93/24476; EP
590267; WO 94/20089; U.S. Pat. Nos. 5,294,637; 5,283,253;
5,279,949; 5,274,137; 5,202,448; 5,200,534; 5,229,529; 5,254,580;
5,412,092; 5,395,850; 5,380,751; 5,350,866; 4,857,653; 5,272,171;
5,411,984; 5,248,796; 5,248,796; 5,422,364; 5,300,638; 5,294,637;
5,362,831; 5,440,056; 4,814,470; 5,278,324; 5,352,805; 5,411,984;
5,059,699; 4,942,184; Tetrahedron Letters 35(52):9709-9712, 1994;
J. Med. Chem. 35:4230-4237, 1992; J. Med. Chem. 34:992-998, 1991;
J. Natural Prod. 57(10):1404-1410, 1994; J. Natural Prod.
57(11):1580-1583, 1994; J. Am. Chem. Soc. 110:6558-6560, 1988), or
obtained from a variety of commercial sources, including for
example, Sigma Chemical Co., St. Louis, Mo. (T7402--from Taxus
brevifolia).
[0183] Representative examples of paclitaxel derivatives or
analogues include 7-deoxy-docetaxol, 7,8-cyclopropataxanes,
N-substituted 2-azetidones, 6,7-epoxy paclitaxels, 6,7-modified
paclitaxels, 10-desacetoxytaxol, 10-deacetyltaxol (from
10-deacetylbaccatin III), phosphonooxy and carbonate derivatives of
taxol, taxol 2',7-di(sodium 1,2-benzenedicarboxylate,
10-desacetoxy-11,12-dihydrotaxol-10,12(18)-dien- e derivatives,
10-desacetoxytaxol, Protaxol (2'- and/or 7-O-ester derivatives),
(2'-and/or 7-O-carbonate derivatives), asymmetric synthesis of
taxol side chain, fluoro taxols, 9-deoxotaxane,
(13-acetyl-9-deoxobaccatine III, 9-deoxotaxol,
7-deoxy-9-deoxotaxol, 10-desacetoxy-7-deoxy-9-deoxotaxol,
Derivatives containing hydrogen or acetyl group and a hydroxy and
tert-butoxycarbonylamino, sulfonated 2'-acryloyltaxol and
sulfonated 2'-O-acyl acid taxol derivatives, succinyltaxol,
2'-.gamma.-aminobutyryltaxol formate, 2'-acetyl taxol, 7-acetyl
taxol, 7-glycine carbamate taxol, 2'-OH-7-PEG(5000) carbamate
taxol, 2'-benzoyl and 2',7-dibenzoyl taxol derivatives, other
prodrugs (2'-acetyltaxol; 2',7-diacetyltaxol; 2'succinyltaxol;
2'-(beta-alanyl)-taxol); 2'gamma-aminobutyryltaxol formate;
ethylene glycol derivatives of 2'-succinyltaxol; 2'-glutaryltaxol;
2'-(N,N-dimethylglycyl)taxol;
2'-(2-(N,N-dimethylamino)propionyl)taxol; 2'orthocarboxybenzoyl
taxol; 2'aliphatic carboxylic acid derivatives of taxol, Prodrugs
{2'(N,N-diethylaminopropionyl)taxol, 2'(N,N-dimethylglycyl)taxol,
7(N,N-dimethylglycyl)taxol, 2',7-di-(N,N-dimethylglycyl)taxol,
7(N,N-diethylaminopropionyl)taxol,
2',7-di(N,N-diethylaminopropionyl)taxol, 2'-(L-glycyl)taxol,
7-(L-glycyl)taxol, 2',7-di(L-glycyl)taxol, 2'-(L-alanyl)taxol,
7-(L-alanyl)taxol, 2',7-di(L-alanyl)taxol, 2'-(L-leucyl)taxol,
7-(L-leucyl)taxol, 2',7-di(L-leucyl)taxol, 2'-(L-isoleucyl)taxol,
7-(L-isoleucyl)taxol, 2',7-di(L-isoleucyl)taxol, 2'-(L-valyl)taxol,
7-(L-valyl)taxol, 2'7-di(L-valyl)taxol, 2'-(L-phenylalanyl)taxol,
7-(L-phenylalanyl)taxol, 2',7-di(L-phenylalanyl)taxol,
2'-(L-prolyl)taxol, 7-(L-prolyl)taxol, 2',7-di(L-prolyl)taxol,
2'-(L-lysyl)taxol, 7-(L-lysyl)taxol, 2',7-di(L-lysyl)taxol,
2'-(L-glutamyl)taxol, 7-(L-glutamyl)taxol,
2',7-di(L-glutamyl)taxol, 2'-(L-arginyl)taxol, 7-(L-arginyl)taxol,
2',7-di(L-arginyl)taxol}, taxol analogues with modified
phenylisoserine side chains, TAXOTERE,
(N-debenzoyl-N-tert-(butoxycaronyl)-10-deacetyltaxol, and taxanes
(e.g., baccatin III, cephalomannine, 10-deacetylbaccatin III,
brevifoliol, yunantaxusin and taxusin); and other taxane analogues
and derivatives, including 14-beta-hydroxy-10 deacetybaccatin III,
debenzoyl-2-acyl paclitaxel derivatives, benzoate paclitaxel
derivatives, phosphonooxy and carbonate paclitaxel derivatives,
sulfonated 2'-acryloyltaxol; sulfonated 2'-O-acyl acid paclitaxel
derivatives, 18-site-substituted paclitaxel derivatives,
chlorinated paclitaxel analogues, C4 methoxy ether paclitaxel
derivatives, sulfenamide taxane derivatives, brominated paclitaxel
analogues, Girard taxane derivatives, nitrophenyl paclitaxel,
10-deacetylated substituted paclitaxel derivatives,
14-beta-hydroxy-10 deacetylbaccatin III taxane derivatives, C7
taxane derivatives, C10 taxane derivatives, 2-debenzoyl-2-acyl
taxane derivatives, 2-debenzoyl and -2-acyl paclitaxel derivatives,
taxane and baccatin III analogues bearing new C2 and C4 functional
groups, n-acyl paclitaxel analogues, 10-deacetylbaccatin III and
7-protected-10-deacetylbaccatin III derivatives from 10-deacetyl
taxol A, 10-deacetyl taxol B, and 10-deacetyl taxol, benzoate
derivatives of taxol, 2-aroyl-4-acyl paclitaxel analogues,
orthro-ester paclitaxel analogues, 2-aroyl-4-acyl paclitaxel
analogues and 1-deoxy paclitaxel and 1-deoxy paclitaxel
analogues.
[0184] In one aspect, the cell cycle inhibitor is a taxane having
the formula (C1): 1
[0185] where the gray-highlighted portions may be substituted and
the non-highlighted portion is the taxane core. A side-chain
(labeled "A" in the diagram) is desirably present in order for the
compound to have good activity as a cell cycle inhibitor. Examples
of compounds having this structure include paclitaxel (Merck Index
entry 7117), docetaxol (TAXOTERE, Merck Index entry 3458), and
3'-desphenyl-3'-(4-ntirophenyl)-N-
-debenzoyl-N-(t-butoxycarbonyl)-10-deacetyltaxol.
[0186] In one aspect, suitable taxanes such as paclitaxel and its
analogues and derivatives are disclosed in U.S. Pat. No. 5,440,056
as having the structure (C2): 2
[0187] wherein X may be oxygen (paclitaxel), hydrogen (9-deoxy
derivatives), thioacyl, or dihydroxyl precursors; R.sub.1 is
selected from paclitaxel or TAXOTERE side chains or alkanoyl of the
formula (C3) 3
[0188] wherein R.sub.7 is selected from hydrogen, alkyl, phenyl,
alkoxy, amino, phenoxy (substituted or unsubstituted); R.sub.8 is
selected from hydrogen, alkyl, hydroxyalkyl, alkoxyalkyl,
aminoalkyl, phenyl (substituted or unsubstituted), alpha or
beta-naphthyl; and R.sub.9 is selected from hydrogen, alkanoyl,
substituted alkanoyl, and aminoalkanoyl; where substitutions refer
to hydroxyl, sulfhydryl, allalkoxyl, carboxyl, halogen,
thioalkoxyl, N,N-dimethylamino, alkylamino, dialkylamino, nitro,
and --OSO.sub.3H, and/or may refer to groups containing such
substitutions; R.sub.2 is selected from hydrogen or
oxygen-containing groups, such as hydrogen, hydroxyl, alkoyl,
alkanoyloxy, aminoalkanoyloxy, and peptidyalkanoyloxy; R.sub.3 is
selected from hydrogen or oxygen-containing groups, such as
hydrogen, hydroxyl, alkoyl, alkanoyloxy, aminoalkanoyloxy, and
peptidyalkanoyloxy, and may further be a silyl containing group or
a sulphur containing group; R.sub.4 is selected from acyl, alkyl,
alkanoyl, aminoalkanoyl, peptidylalkanoyl and aroyl; R.sub.5 is
selected from acyl, alkyl, alkanoyl, aminoalkanoyl,
peptidylalkanoyl and aroyl; R.sub.6 is selected from hydrogen or
oxygen-containing groups, such as hydrogen, hydroxyl alkoyl,
alkanoyloxy, aminoalkanoyloxy, and peptidyalkanoyloxy.
[0189] In one aspect, the paclitaxel analogues and derivatives
useful as cell cycle inhibitors are disclosed in PCT International
Patent Application No. WO 93/10076. As disclosed in this
publication, the analogue or derivative should have a side chain
attached to the taxane nucleus at C.sub.13, as shown in the
structure below (formula C4), in order to confer antitumor activity
to the taxane. 4
[0190] WO 93/10076 discloses that the taxane nucleus may be
substituted at any position with the exception of the existing
methyl groups. The substitutions may include, for example,
hydrogen, alkanoyloxy, alkenoyloxy, aryloyloxy. In addition, oxo
groups may be attached to carbons labeled 2, 4, 9, and/or 10. As
well, an oxetane ring may be attached at carbons 4 and 5. As well,
an oxirane ring may be attached to the carbon labeled 4.
[0191] In one aspect, the taxane-based cell cycle inhibitor useful
in the present invention is disclosed in U.S. Pat. No. 5,440,056,
which discloses 9-deoxo taxanes. These are compounds lacking an oxo
group at the carbon labeled 9 in the taxane structure shown above
(formula C4). The taxane ring may be substituted at the carbons
labeled 1, 7 and 10 (independently) with H, OH, O--R, or O--CO--R
where R is an alkyl or an aminoalkyl. As well, it may be
substituted at carbons labeled 2 and 4 (independently) with aryol,
alkanoyl, aminoalkanoyl or alkyl groups. The side chain of formula
(C3) may be substituted at R.sub.7 and R.sub.8 (independently) with
phenyl rings, substituted phenyl rings, linear alkanes/alkenes, and
groups containing H, O or N. R.sub.9 may be substituted with H, or
a substituted or unsubstituted alkanoyl group.
[0192] Taxanes in general, and paclitaxel is particular, is
considered to function as a cell cycle inhibitor by acting as an
anti-microtubule agent, and more specifically as a stabilizer.
These compounds have been shown useful in the treatment of
proliferative disorders, including: non-small cell (NSC) lung;
small cell lung; breast; prostate; cervical; endometrial; head and
neck cancers.
[0193] In another aspect, the anti-microtuble agent (microtubule
inhibitor) is albendazole (carbamic acid,
[5-(propylthio)-1H-benzimidazol- -2-yl]-, methyl ester), LY-355703
(1,4-dioxa-8,11-diazacyclohexadec-13-ene- -2,5,9,12-tetrone,
10-[(3-chloro-4-methoxyphenyl)methyl]-6,6-dimethyl-3-(2-
-methylpropyl)-16-[(1S)-1-[(2S ,3R)-3-phenyloxiranyl]ethyl]-,
(3S,10R,13E,16S)-), vindesine (vincaleukoblastine,
3-(aminocarbonyl)-O4-deacetyl-3-de(methoxycarbonyl)-), or
WAY-174286
[0194] In another aspect, the cell cycle inhibitor is a vinca
alkaloid. Vinca alkaloids have the following general structure.
They are indole-dihydroindole dimers. 5
[0195] As disclosed in U.S. Pat. Nos. 4,841,045 and 5,030,620,
R.sub.1 can be a formyl or methyl group or alternately H. R.sub.1
can also be an alkyl group or an aldehyde-substituted alkyl (e.g.,
CH.sub.2CHO). R.sub.2 is typically a CH.sub.3 or NH.sub.2 group.
However it can be alternately substituted with a lower alkyl ester
or the ester linking to the dihydroindole core may be substituted
with C(O)--R where R is NH.sub.2, an amino acid ester or a peptide
ester. R.sub.3 is typically C(O)CH.sub.3, CH.sub.3 or H.
Alternately, a protein fragment may be linked by a bifunctional
group, such as maleoyl amino acid. R.sub.3 can also be substituted
to form an alkyl ester which may be further substituted. R.sub.4
may be --CH.sub.2-- or a single bond. R.sub.5 and R.sub.6 may be H,
OH or a lower alkyl, typically --CH.sub.2CH.sub.3. Alternatively
R.sub.6 and R.sub.7 may together form an oxetane ring. R.sub.7 may
alternately be H. Further substitutions include molecules wherein
methyl groups are substituted with other alkyl groups, and whereby
unsaturated rings may be derivatized by the addition of a side
group such as an alkane, alkene, alkyne, halogen, ester, amide or
amino group.
[0196] Exemplary vinca alkaloids are vinblastine, vincristine,
vincristine sulfate, vindesine, and vinorelbine, having the
structures:
1 6 R.sub.1 R.sub.2 R.sub.3 R.sub.4 R.sub.5 Vinblastine: CH.sub.3
CH.sub.3 C(O)CH.sub.3 OH CH.sub.2 Vincristine: CH.sub.2O CH.sub.3
C(O)CH.sub.3 OH CH.sub.2 Vindesine: CH.sub.3 NH.sub.2 H OH CH.sub.2
Vinorelbine: CH.sub.3 CH.sub.3 CH.sub.3 H single bond
[0197] Analogues typically require the side group (shaded area) in
order to have activity. These compounds are thought to act as cell
cycle inhibitors by functioning as anti-microtubule agents, and
more specifically to inhibit polymerization. These compounds have
been shown useful in treating proliferative disorders, including
NSC lung; small cell lung; breast; prostate; brain; head and neck;
retinoblastoma; bladder; and penile cancers; and soft tissue
sarcoma.
[0198] In another aspect, the cell cycle inhibitor is a
camptothecin, or an anolog or derivative thereof. Camptothecins
have the following general structure. 7
[0199] In this structure, X is typically O, but can be other
groups, e.g., NH in the case of 21-lactam derivatives. R.sub.1 is
typically H or OH, but may be other groups, e.g., a terminally
hydroxylated C.sub.1-3 alkane. R.sub.2 is typically H or an amino
containing group such as (CH.sub.3).sub.2NHCH.sub.2, but may be
other groups e.g., NO.sub.2, NH.sub.2, halogen (as disclosed in,
e.g., U.S. Pat. No. 5,552,156) or a short alkane containing these
groups. R.sub.3 is typically H or a short alkyl such as
C.sub.2H.sub.5. R.sub.4 is typically H but may be other groups,
e.g., a methylenedioxy group with R.sub.1.
[0200] Exemplary camptothecin compounds include topotecan,
irinotecan (CPT-11), 9-aminocamptothecin,
21-lactam-20(S)-camptothecin, 10,11-methylenedioxycamptothecin,
SN-38, 9-nitrocamptothecin, 10-hydroxycamptothecin. Exemplary
compounds have the structures:
2 8 R.sub.1 R.sub.2 R.sub.3 Camptothecin: H H H Topotecan: OH
(CH.sub.3).sub.2NHCH.sub.2 H SN-38: OH H C.sub.2H.sub.5 X: O for
most analogs, NH for 21-lactam analogs
[0201] Camptothecins have the five rings shown here. The ring
labeled E must be intact (the lactone rather than carboxylate form)
for maximum activity and minimum toxicity. These compounds are
useful to as cell cycle inhibitors, where they can function as
topoisomerase I inhibitors and/or DNA cleavage agents. They have
been shown useful in the treatment of proliferative disorders,
including, for example, NSC lung; small cell lung; and cervical
cancers.
[0202] In another aspect, the cell cycle inhibitor is a
podophyllotoxin, or a derivative or an analogue thereof. Exemplary
compounds of this type are etoposide or teniposide, which have the
following structures:
3 9 R Etoposide CH.sub.3 Teniposide 10
[0203] These compounds are thought to function as cell cycle
inhibitors by being topoisomerase II inhibitors and/or by DNA
cleaving agents. They have been shown useful as antiproliferative
agents in, e.g., small cell lung, prostate, and brain cancers, and
in retinoblastoma.
[0204] Another example of a DNA topoisomerase inhibitor is
lurtotecan dihydrochloride
(11H-1,4-dioxino[2,3-g]pyrano[3',4':6,7]indolizino[1,2-b]-
quinoline-9,12(8H,14H )-dione,
8-ethyl-2,3-dihydro-8-hydroxy-15-[(4-methyl-
-1-piperazinyl)methyl]-, dihydrochloride, (S)-).
[0205] In another aspect, the cell cycle inhibitor is an
anthracycline. Anthracyclines have the following general structure,
where the R groups may be a variety of organic groups: 11
[0206] According to U.S. Pat. No. 5,594,158, suitable R groups are:
R.sub.1 is CH.sub.3 or CH.sub.2OH; R.sub.2 is daunosamine or H;
R.sub.3 and R.sub.4 are independently one of OH, NO.sub.2,
NH.sub.2, F, Cl, Br, I, CN, H or groups derived from these;
R.sub.5-7 are all H or R.sub.5 and R.sub.6 are H and R.sub.7 and
R.sub.8 are alkyl or halogen, or vice versa: R.sub.7 and R.sub.8
are H and R.sub.5 and R.sub.6 are alkyl or halogen.
[0207] According to U.S. Pat. No. 5,843,903, R.sub.2 may be a
conjugated peptide. According to U.S. Pat. Nos. 4,215,062 and
4,296,105, R.sub.5 may be OH or an ether linked alkyl group.
R.sub.1 may also be linked to the anthracycline ring by a group
other than C(O), such as an alkyl or branched alkyl group having
the C(O) linking moiety at its end, such as
--CH.sub.2CH(CH.sub.2--X)C(O)--R.sub.1, wherein X is H or an alkyl
group (see, e.g., U.S. Pat. No. 4,215,062). R.sub.2 may alternately
be a group linked by the functional group .dbd.N--NHC(O)--Y, where
Y is a group such as a phenyl or substituted phenyl ring.
Alternately R.sub.3 may have the following structure: 12
[0208] in which R.sub.9 is OH either in or out of the plane of the
ring, or is a second sugar moiety such as R.sub.3. R.sub.10 may be
H or form a secondary amine with a group such as an aromatic group,
saturated or partially saturated 5 or 6 membered heterocyclic
having at least one ring nitrogen (see U.S. Pat. No. 5,843,903).
Alternately, R.sub.10 may be derived from an amino acid, having the
structure --C(O)CH(NHR.sub.11)(R.s- ub.12), in which R.sub.11 is H,
or forms a C.sub.3-4 membered alkylene with R.sub.12. R.sub.12 may
be H, alkyl, aminoalkyl, amino, hydroxy, mercapto, phenyl, benzyl
or methylthio (see U.S. Pat. No. 4,296,105).
[0209] Exemplary anthracyclines are doxorubicin, daunorubicin,
idarubicin, epirubicin, pirarubicin, zorubicin, and carubicin.
Suitable compounds have the structures:
4 13 R.sub.1 R.sub.2 R.sub.3 Doxorubicin: OCH.sub.3 CH.sub.2OH OH
out of ring plane Epirubicin: OCH.sub.3 CH.sub.2OH OH in ring plane
(4' epimer, of doxorubicin) Daunorubicin: OCH.sub.3 CH.sub.3 OH out
of ring plane Idarubicin: H CH.sub.3 OH out of ring plane
Pirarubicin OCH.sub.3 OH A Zorubicin OCH.sub.3
.dbd.N--NHC(O)C.sub.6H.sub.5 B Carubicin OH CH.sub.3 B 14 15
[0210] Other suitable anthracyclines are anthramycin, mitoxantrone,
menogaril, nogalamycin, aclacinomycin A, olivomycin A, chromomycin
A.sub.3, and plicamycin having the structures:
5 16 17 18 R.sub.1 R.sub.2 R.sub.3 R.sub.4 Olivomycin A
COCH(CH.sub.3).sub.2 CH.sub.3 COCH.sub.3 H Chromomycin A.sub.3
COCH.sub.3 CH.sub.3 COCH.sub.3 CH.sub.3 Plicamycin H H H CH.sub.3
19 R.sub.1 R.sub.2 R.sub.3 Menogaril H OCH.sub.3 H Nogalamycin
O-sugar H COOCH.sub.3 20 21
[0211] These compounds are thought to function as cell cycle
inhibitors by being topoisomerase inhibitors and/or by DNA cleaving
agents. They have been shown useful in the treatment of
proliferative disorders, including small cell lung; breast;
endometrial; head and neck; retinoblastoma; liver; bile duct; islet
cell; and bladder cancers; and soft tissue sarcoma.
[0212] In another aspect, the cell cycle inhibitor is a platinum
compound. In general, suitable platinum complexes may be of Pt(II)
or Pt(IV) and have this basic structure: 22
[0213] wherein X and Y are anionic leaving groups such as sulfate,
phosphate, carboxylate, and halogen; R.sub.1 and R.sub.2 are alkyl,
amine, amino alkyl any may be further substituted, and are
basically inert or bridging groups. For Pt(II) complexes Z.sub.1
and Z.sub.2 are non-existent. For Pt(IV) Z.sub.1 and Z.sub.2 may be
anionic groups such as halogen, hydroxy, carboxylate, ester,
sulfate or phosphate. See, e.g., U.S. Pat. Nos. 4,588,831 and
4,250,189.
[0214] Suitable platinum complexes may contain multiple Pt atoms.
See, e.g., U.S. Pat. Nos. 5,409,915 and 5,380,897. For example
bisplatinum and triplatinum complexes of the type: 23
[0215] Exemplary platinum compounds are cisplatin, carboplatin,
oxaliplatin, and miboplatin having the structures: 24
[0216] These compounds are thought to function as cell cycle
inhibitors by binding to DNA, i.e., acting as alkylating agents of
DNA. These compounds have been shown useful in the treatment of
cell proliferative disorders, including, e.g., NSC lung; small cell
lung; breast; cervical; brain; head and neck; esophageal;
retinoblastom; liver; bile duct; bladder; penile; and vulvar
cancers; and soft tissue sarcoma.
[0217] In another aspect, the cell cycle inhibitor is a
nitrosourea. Nitrosourease have the following general structure
(C5), where typical R groups are shown below. 25
[0218] Other suitable R groups include cyclic alkanes, alkanes,
halogen substituted groups, sugars, aryl and heteroaryl groups,
phosphonyl and sulfonyl groups. As disclosed in U.S. Pat. No.
4,367,239, R may suitably be CH.sub.2--C(X)(Y)(Z), wherein X and Y
may be the same or different members of the following groups:
phenyl, cyclyhexyl, or a phenyl or cyclohexyl group substituted
with groups such as halogen, lower alkyl (C.sub.1-4), trifluore
methyl, cyano, phenyl, cyclohexyl, lower alkyloxy (C.sub.1-4). Z
has the following structure: -alkylene-N-R.sub.1R.sub.2, where
R.sub.1 and R.sub.2 may be the same or different members of the
following group: lower alkyl (C.sub.1-4) and benzyl, or together
R.sub.1 and R.sub.2 may form a saturated 5 or 6 membered
heterocyclic such as pyrrolidine, piperidine, morfoline,
thiomorfoline, N-lower alkyl piperazine, where the heterocyclic may
be optionally substituted with lower alkyl groups.
[0219] As disclosed in U.S. Pat. No. 6,096,923, R and R' of formula
(C5) may be the same or different, where each may be a substituted
or unsubstituted hydrocarbon having 1-10 carbons. Substitutions may
include hydrocarbyl, halo, ester, amide, carboxylic acid, ether,
thioether and alcohol groups. As disclosed in U.S. Pat. No.
4,472,379, R of formula (C5) may be an amide bond and a pyranose
structure (e.g., methyl
2'-(N--(N-(2-chloroethyl)-N-nitroso-carbamoyl)-glycyl)amino-2'-deoxy-.alp-
ha.-D-glucopyranoside). As disclosed in U.S. Pat. No. 4,150,146, R
of formula (C5) may be an alkyl group of 2 to 6 carbons and may be
substituted with an ester, sulfonyl, or hydroxyl group. It may also
be substituted with a carboxylic acid or CONH.sub.2 group.
[0220] Exemplary nitrosoureas are BCNU (carmustine), methyl-CCNU
(semustine), CCNU (lomustine), ranimustine, nimustine,
chlorozotocin, fotemustine, and streptozocin, having the
structures: 26
[0221] These nitrosourea compounds are thought to function as cell
cycle inhibitors by binding to DNA, that is, by functioning as DNA
alkylating agents. These cell cycle inhibitors have been shown
useful in treating cell proliferative disorders such as, for
example, islet cell; small cell lung; melanoma; and brain
cancers.
[0222] In another aspect, the cell cycle inhibitor is a
nitroimidazole, where exemplary nitroimidazoles are metronidazole,
benznidazole, etanidazole, and misonidazole, having the
structures:
6 27 R.sub.1 R.sub.2 R.sub.3 Metronidazole OH CH.sub.3 NO.sub.2
Benznidazole C(O)NHCH.sub.2-benzyl NO.sub.2 H Etanidazole
CONHCH.sub.2CH.sub.2OH NO.sub.2 H
[0223] Suitable nitroimidazole compounds are disclosed in, e.g.,
U.S. Pat. Nos. 4,371,540 and 4,462,992.
[0224] In another aspect, the cell cycle inhibitor is a folic acid
antagonist, such as methotrexate or derivatives or analogues
thereof, including edatrexate, trimetrexate, raltitrexed,
piritrexim, denopterin, tomudex, and pteropterin. Methotrexate
analogues have the following general structure: 28
[0225] The identity of the R group may be selected from organic
groups, particularly those groups set forth in U.S. Pat. Nos.
5,166,149 and 5,382,582. For example, R.sub.1 may be N, R.sub.2 may
be N or C(CH.sub.3), R.sub.3 and R.sub.3' may H or alkyl, e.g.,
CH.sub.3, R.sub.4 may be a single bond or NR, where R is H or alkyl
group. R.sub.5,6,8 may be H, OCH.sub.3, or alternately they can be
halogens or hydro groups. R.sub.7 is a side chain of the general
structure: 29
[0226] wherein n=1 for methotrexate, n=3 for pteropterin. The
carboxyl groups in the side chain may be esterified or form a salt
such as a Zn.sup.2+ salt. R.sub.9 and R.sub.10 can be NH.sub.2 or
may be alkyl substituted.
[0227] Exemplary folic acid antagonist compounds have the
structures:
7 30 R.sub.0 R.sub.1 R.sub.2 R.sub.3 R.sub.4 R.sub.5 R.sub.6
R.sub.7 R.sub.8 Methotrexate NH.sub.2 N N H N(CH.sub.3) H H A(n =
1) H Edatrexate NH.sub.2 N N H N(CH.sub.2CH.sub.3) H H A(n = 1) H
Trimetrexate NH.sub.2 N C(CH.sub.3) H NH H OCH.sub.3 OCH.sub.3
OCH.sub.3 Pteropterin NH.sub.2 N N H N(CH.sub.3) H H A(n = 3) H
Denopterin OH N N CH.sub.3 N(CH.sub.3) H H A(n = 1) H Piritrexim
NH.sub.2 N C(CH.sub.3)H single OCH.sub.3 H H OCH.sub.3 H bond 31
32
[0228] These compounds are thought to function as cell cycle
inhibitors by serving as antimetabolites of folic acid. They have
been shown useful in the treatment of cell proliferative disorders
including, for example, soft tissue sarcoma, small cell lung,
breast, brain, head and neck, bladder, and penile cancers.
[0229] In another aspect, the cell cycle inhibitor is a cytidine
analogue, such as cytarabine or derivatives or analogues thereof,
including enocitabine, FMdC
((E(-2'-deoxy-2'-(fluoromethylene)cytidine), gemcitabine,
5-azacitidine, ancitabine, and 6-azauridine. Exemplary compounds
have the structures:
8 33 R.sub.1 R.sub.2 R.sub.3 R.sub.4 Cytarabine H OH H CH
Enocitabine C(O)(CH.sub.2).sub.20CH.sub.3 OH H CH Gemcitabine H F F
CH Azacitidine H H OH N FMdC H CH.sub.2F H CH 34
[0230] These compounds are thought to function as cell cycle
inhibitors as acting as antimetabolites of pyrimidine. These
compounds have been shown useful in the treatment of cell
proliferative disorders including, for example, pancreatic, breast,
cervical, NSC lung, and bile duct cancers.
[0231] In another aspect, the cell cycle inhibitor is a pyrimidine
analogue. In one aspect, the pyrimidine analogues have the general
structure: 35
[0232] wherein positions 2', 3' and 5' on the sugar ring (R.sub.2,
R.sub.3 and R.sub.4, respectively) can be H, hydroxyl, phosphoryl
(see, e.g., U.S. Pat. No. 4,086,417) or ester (see, e.g., U.S. Pat.
No. 3,894,000). Esters can be of alkyl, cycloalkyl, aryl or
heterocyclo/aryl types. The 2' carbon can be hydroxylated at either
R.sub.2 or R.sub.2', the other group is H. Alternately, the 2'
carbon can be substituted with halogens e.g., fluoro or difluoro
cytidines such as Gemcytabine. Alternately, the sugar can be
substituted for another heterocyclic group such as a furyl group or
for an alkane, an alkyl ether or an amide linked alkane such as
C(O)NH(CH.sub.2).sub.5CH.sub.3. The 2.degree. amine can be
substituted with an aliphatic acyl (R.sub.1) linked with an amide
(see, e.g., U.S. Pat. No. 3,991,045) or urethane (see, e.g., U.S.
Pat. No. 3,894,000) bond. It can also be further substituted to
form a quaternary ammonium salt. R.sub.5 in the pyrimidine ring may
be N or CR, where R is H, halogen containing groups, or alkyl (see,
e.g., U.S. Pat. No. 4,086,417). R.sub.6 and R.sub.7 can together
can form an oxo group or R.sub.6.dbd.--NH--R.sub.1 and
R.sub.7.dbd.H. R.sub.8 is H or R.sub.7 and R.sub.8 together can
form a double bond or R.sub.8 can be X, where X is: 36
[0233] Specific pyrimidine analogues are disclosed in U.S. Pat. No.
3,894,000 (see, e.g., 2'-O-palmityl-ara-cytidine,
3'-O-benzoyl-ara-cytidi- ne, and more than 10 other examples); U.S.
Pat. No. 3,991,045 (see, e.g.,
N4-acyl-1-.beta.-D-arabinofuranosylcytosine, and numerous acyl
groups derivatives as listed therein, such as palmitoyl.
[0234] In another aspect, the cell cycle inhibitor is a
fluoropyrimidine analogue, such as 5-fluorouracil, or an analogue
or derivative thereof, including carmofur, doxifluridine, emitefur,
tegafur, and floxuridine. Exemplary compounds have the
structures:
9 37 R.sub.1 R.sub.2 5-Fluorouracil H H Carmofur
C(O)NH(CH.sub.2).sub.5CH.sub.3 H Doxifluridine A.sub.1 H
Floxuridine A.sub.2 H Emitefur CH.sub.2OCH.sub.2CH.sub.3 B Tegafur
H 38 39 40 41
[0235] Other suitable fluoropyrimidine analogues include 5-FudR
(5-fluoro-deoxyuridine), or an analogue or derivative thereof,
including 5-iododeoxyuridine (5-ludR), 5-bromodeoxyuridine
(5-BudR), fluorouridine triphosphate (5-FUTP), and
fluorodeoxyuridine monophosphate (5-dFUMP). Exemplary compounds
have the structures:
10 42 5-Fluoro-2'-deoxyuridine: R = F 5-Bromo-2'-deoxyuridine: R =
Br 5-Iodoo-2'-deoxyuridine: R = I
[0236] These compounds are thought to function as cell cycle
inhibitors by serving as antimetabolites of pyrimidine. These
compounds have been shown useful in the treatment of cell
proliferative disorders such as breast, cervical, non-melanoma
skin, head and neck, esophageal, bile duct, pancreatic, islet cell,
penile, and vulvar cancers.
[0237] In another aspect, the cell cycle inhibitor is a purine
analogue. Purine analogues have the following general structure.
43
[0238] wherein X is typically carbon; R.sub.1 is H, halogen, amine
or a substituted phenyl; R.sub.2 is H, a primary, secondary or
tertiary amine, a sulfur containing group, typically --SH, an
alkane, a cyclic alkane, a heterocyclic or a sugar; R.sub.3 is H, a
sugar (typically a furanose or pyranose structure), a substituted
sugar or a cyclic or heterocyclic alkane or aryl group. See, e.g.,
U.S. Pat. No. 5,602,140 for compounds of this type.
[0239] In the case of pentostatin, X--R2 is --CH.sub.2CH(OH)--. In
this case a second carbon atom is inserted in the ring between X
and the adjacent nitrogen atom. The X--N double bond becomes a
single bond.
[0240] U.S. Pat. No. 5,446,139 describes suitable purine analogues
of the type shown in the formula. 44
[0241] wherein N signifies nitrogen and V, W, X, Z can be either
carbon or nitrogen with the following provisos. Ring A may have 0
to 3 nitrogen atoms in its structure. If two nitrogens are present
in ring A, one must be in the W position. If only one is present,
it must not be in the Q position. V and Q must not be
simultaneously nitrogen. Z and Q must not be simultaneously
nitrogen. If Z is nitrogen, R.sub.3 is not present. Furthermore,
R.sub.1-3 are independently one of H, halogen, C.sub.1-7 alkyl,
C.sub.1-7 alkenyl, hydroxyl, mercapto, C.sub.1-7 alkylthio,
C.sub.1-7 alkoxy, C.sub.2-7 alkenyloxy, aryl oxy, nitro, primary,
secondary or tertiary amine containing group. R.sub.5-8 are H or up
to two of the positions may contain independently one of OH,
halogen, cyano, azido, substituted amino, R.sub.5 and R.sub.7 can
together form a double bond. Y is H, a C.sub.1-7 alkylcarbonyl, or
a mono- di or tri phosphate.
[0242] Exemplary suitable purine analogues include
6-mercaptopurine, thiguanosine, thiamiprine, cladribine,
fludaribine, tubercidin, puromycin, pentoxyfilline; where these
compounds may optionally be phosphorylated. Exemplary compounds
have the structures:
11 45 R.sub.1 R.sub.2 R.sub.3 6-Mercaptopurine H SH H Thioguanosine
NH.sub.2 SH B.sub.1 Thiamiprine NH.sub.2 A H Cladribine Cl NH.sub.2
B.sub.2 Fludarabine F NH.sub.2 B.sub.3 Puromycin H
N(CH.sub.3).sub.2 B.sub.4 Tubercidin H NH.sub.2 B.sub.1 46 47 48 49
50 51
[0243] These compounds are thought to function as cell cycle
inhibitors by serving as antimetabolites of purine.
[0244] In another aspect, the cell cycle inhibitor is a nitrogen
mustard. Many suitable nitrogen mustards are known and are suitably
used as a cell cycle inhibitor in the present invention. Suitable
nitrogen mustards are also known as cyclophosphamides.
[0245] A preferred nitrogen mustard has the general structure:
52
[0246] Where A is: 53
[0247] or --CH.sub.3 or other alkane, or chloronated alkane,
typically CH.sub.2CH(CH.sub.3)Cl, or a polycyclic group such as B,
or a substituted phenyl such as C or a heterocyclic group such as
D. 54
[0248] Examples of suitable nitrogen mustards are disclosed in U.S.
Pat. No. 3,808,297, wherein A is: 55
[0249] R.sub.1-2 are H or CH.sub.2CH.sub.2Cl; R.sub.3 is H or
oxygen-containing groups such as hydroperoxy; and R.sub.4 can be
alkyl, aryl, heterocyclic.
[0250] The cyclic moiety need not be intact. See, e.g., U.S. Pat.
Nos. 5,472,956, 4,908,356, 4,841,085 that describe the following
type of structure: 56
[0251] wherein R.sub.1 is H or CH.sub.2CH.sub.2Cl, and R.sub.2-6
are various substituent groups.
[0252] Exemplary nitrogen mustards include methylchloroethamine,
and analogues or derivatives thereof, including
methylchloroethamine oxide hydrohchloride, novembichin, and
mannomustine (a halogenated sugar). Exemplary compounds have the
structures:
12 57 R Mechlorethanime CH.sub.3 Novembichin CH.sub.2CH(CH.sub.3)Cl
58 Mechlorethanime Oxide HCl
[0253] The nitrogen mustard may be cyclophosphamide, ifosfamide,
perfosfamide, or torofosfamide, where these compounds have the
structures:
13 59 R.sub.1 R.sub.2 R.sub.3 Cyclophosphamide H CH.sub.2CH.sub.2Cl
H Ifosfamide CH.sub.2CH.sub.2Cl H H Perfosfamide CH.sub.2CH.sub.2Cl
H OOH Torofosfamide CH.sub.2CH.sub.2Cl CH.sub.2CH.sub.2Cl H
[0254] The nitrogen mustard may be estramustine, or an analogue or
derivative thereof, including phenesterine, prednimustine, and
estramustine PO.sub.4. Thus, suitable nitrogen mustard type cell
cycle inhibitors of the present invention have the structures:
14 60 R Estramustine OH Phenesterine
C(CH.sub.3)(CH.sub.2).sub.3CH(CH.sub- .3).sub.2 61
[0255] The nitrogen mustard may be chlorambucil, or an analogue or
derivative thereof, including melphalan and chlormaphazine. Thus,
suitable nitrogen mustard type cell cycle inhibitors of the present
invention have the structures:
15 62 R.sub.1 R.sub.2 R.sub.3 Chlorambucil CH.sub.2COOH H H
Melphalan COOH NH.sub.2 H Chlornaphazine H together forms a benzene
ring
[0256] The nitrogen mustard may be uracil mustard, which has the
structure: 63
[0257] The nitrogen mustards are thought to function as cell cycle
inhibitors by serving as alkylating agents for DNA. Nitrogen
mustards have been shown useful in the treatment of cell
proliferative disorders including, for example, small cell lung,
breast, cervical, head and neck, prostate, retinoblastoma, and soft
tissue sarcoma.
[0258] The cell cycle inhibitor of the present invention may be a
hydroxyurea. Hydroxyureas have the following general structure:
64
[0259] Suitable hydroxyureas are disclosed in, for example, U.S.
Pat. No. 6,080,874, wherein R.sub.1 is: 65
[0260] and R.sub.2 is an alkyl group having 1-4 carbons and R.sub.3
is one of H, acyl, methyl, ethyl, and mixtures thereof, such as a
methylether.
[0261] Other suitable hydroxyureas are disclosed in, e.g., U.S.
Pat. No. 5,665,768, wherein R.sub.1 is a cycloalkenyl group, for
example
N-(3-(5-(4-fluorophenylthio)-furyl)-2-cyclopenten-1-yl)N-hydroxyurea;
R.sub.2 is H or an alkyl group having 1 to 4 carbons and R.sub.3 is
H; X is H or a cation.
[0262] Other suitable hydroxyureas are disclosed in, e.g., U.S.
Pat. No. 4,299,778, wherein R.sub.1 is a phenyl group substituted
with on or more fluorine atoms; R.sub.2 is a cyclopropyl group; and
R.sub.3 and X is H.
[0263] Other suitable hydroxyureas are disclosed in, e.g., U.S.
Pat. No. 5,066,658, wherein R.sub.2 and R.sub.3 together with the
adjacent nitrogen form: 66
[0264] wherein m is 1 or 2, n is 0-2 and Y is an alkyl group.
[0265] In one aspect, the hydroxy urea has the structure: 67
[0266] Hydroxyureas are thought to function as cell cycle
inhibitors by serving to inhibit DNA synthesis.
[0267] In another aspect, the cell cycle inhibitor is a mytomicin,
such as mitomycin C, or an analogue or derivative thereof, such as
porphyromycin. Exemplary compounds have the structures:
16 68 R Mitomycin C H Porphyromycin CH.sub.3 (N-methyl Mitomycin
C)
[0268] These compounds are thought to function as cell cycle
inhibitors by serving as DNA alkylating agents. Mitomycins have
been shown useful in the treatment of cell proliferative disorders
such as, for example, esophageal, liver, bladder, and breast
cancers.
[0269] In another aspect, the cell cycle inhibitor is an alkyl
sulfonate, such as busulfan, or an analogue or derivative thereof,
such as treosulfan, improsulfan, piposulfan, and pipobroman.
Exemplary compounds have the structures:
17 69 R Busulfan single band Improsulfan --CH.sub.2--NH--CH.sub.2--
Piposulfan 70 71
[0270] These compounds are thought to function as cell cycle
inhibitors by serving as DNA alkylating agents.
[0271] In another aspect, the cell cycle inhibitor is a benzamide.
In yet another aspect, the cell cycle inhibitor is a nicotinamide.
These compounds have the basic structure: 72
[0272] wherein X is either O or S; A is commonly NH.sub.2 or it can
be OH or an alkoxy group; B is N or C--R.sub.4, where R.sub.4 is H
or an ether-linked hydroxylated alkane such as OCH.sub.2CH.sub.2OH,
the alkane may be linear or branched and may contain one or more
hydroxyl groups. Alternately, B may be N--R.sub.5 in which case the
double bond in the ring involving B is a single bond. R.sub.5 may
be H, and alkyl or an aryl group (see, e.g., U.S. Pat. No.
4,258,052); R.sub.2 is H, OR.sub.6, SR.sub.6 or NHR.sub.6, where
R.sub.6 is an alkyl group; and R.sub.3 is H, a lower alkyl, an
ether linked lower alkyl such as --O-Me or --O-ethyl (see, e.g.,
U.S. Pat. No. 5,215,738).
[0273] Suitable benzamide compounds have the structures: 73
[0274] where additional compounds are disclosed in U.S. Pat. No.
5,215,738, (listing some 32 compounds).
[0275] Suitable nicotinamide compounds have the structures:
18 74 Nicotinamides X = O or S Z = H, OR, SR, NHR R = alkyl
group
[0276] where additional compounds are disclosed in U.S. Pat. No.
5,215,738,
19 75 R.sub.1 R.sub.2 Benzodepa phenyl H Meturedepa CH.sub.3
CH.sub.3 Uredepa CH.sub.3 H 76
[0277] In another aspect, the cell cycle inhibitor is a halogenated
sugar, such as mitolactol, or an analogue or derivative thereof,
including mitobronitol and mannomustine. Exemplary compounds have
the structures:
20 77
[0278] In another aspect, the cell cycle inhibitor is a diazo
compound, such as azaserine, or an analogue or derivative thereof,
including 6-diazo-5-oxo-L-norleucine and 5-diazouracil (also a
pyrimidine analog). Exemplary compounds have the structures:
21 78 R.sub.1 R.sub.2 Azaserine O single bond 6-diazo-5-oxo- single
bond CH.sub.2 L-norleucine
[0279] Other compounds that may serve as cell cycle inhibitors
according to the present invention are pazelliptine; wortmannin;
metoclopramide; RSU; buthionine sulfoxime; tumeric; curcumin;
AG337, a thymidylate synthase inhibitor; levamisole; lentinan, a
polysaccharide; razoxane, an EDTA analogue; indomethacin;
chlorpromazine; .alpha. and .beta. interferon; MnBOPP; gadolinium
texaphyrin; 4-amino-1,8-naphthalimide; staurosporine derivative of
CGP; and SR-2508.
[0280] Thus, in one aspect, the cell cycle inhibitor is a DNA
alylating agent. In another aspect, the cell cycle inhibitor is an
anti-microtubule agent. In another aspect, the cell cycle inhibitor
is a topoisomerase inhibitor. In another aspect, the cell cycle
inhibitor is a DNA cleaving agent. In another aspect, the cell
cycle inhibitor is an antimetabolite. In another aspect, the cell
cycle inhibitor functions by inhibiting adenosine deaminase (e.g.,
as a purine analogue). In another aspect, the cell cycle inhibitor
functions by inhibiting purine ring synthesis and/or as a
nucleotide interconversion inhibitor (e.g., as a purine analogue
such as mercaptopurine). In another aspect, the cell cycle
inhibitor functions by inhibiting dihydrofolate reduction and/or as
a thymidine monophosphate block (e.g., methotrexate). In another
aspect, the cell cycle inhibitor functions by causing DNA damage
(e.g., bleomycin). In another aspect, the cell cycle inhibitor
functions as a DNA intercalation agent and/or RNA synthesis
inhibition (e.g., doxorubicin, aclarubicin, or detorubicin (acetic
acid, diethoxy-, 2-[4-[(3-amino-2,3,6-trideoxy-alpha--
L-lyxo-hexopyranosyl)oxy]-1,2,3,4,6,11-hexahydro-2,5,12-trihydroxy-7-metho-
xy-6,11-dioxo-2-naphthacenyl]-2-oxoethyl ester, (2S-cis)-)). In
another aspect, the cell cycle inhibitor functions by inhibiting
pyrimidine synthesis (e.g., N-phosphonoacetyl-L-aspartate). In
another aspect, the cell cycle inhibitor functions by inhibiting
ribonucleotides (e.g., hydroxyurea). In another aspect, the cell
cycle inhibitor functions by inhibiting thymidine monophosphate
(e.g., 5-fluorouracil). In another aspect, the cell cycle inhibitor
functions by inhibiting DNA synthesis (e.g., cytarabine). In
another aspect, the cell cycle inhibitor functions by causing DNA
adduct formation (e.g., platinum compounds). In another aspect, the
cell cycle inhibitor functions by inhibiting protein synthesis
(e.g., L-asparginase). In another aspect, the cell cycle inhibitor
functions by inhibiting microtubule function (e.g., taxanes). In
another aspect, the cell cycle inhibitor acts at one or more of the
steps in the biological pathway shown in FIG. 1.
[0281] Additional cell cycle inhibitor s useful in the present
invention, as well as a discussion of the mechanisms of action, may
be found in Hardman J. G., Limbird L. E. Molinoff R. B., Ruddon R
W., Gilman A. G. editors, Chemotherapy of Neoplastic Diseases in
Goodman and Gilman's The Pharmacological Basis of Therapeutics
Ninth Edition, McGraw-Hill Health Professions Division, New York,
1996, pages 1225-1287. See also U.S. Pat. Nos. 3,387,001;
3,808,297; 3,894,000; 3,991,045; 4,012,390; 4,057,548; 4,086,417;
4,144,237; 4,150,146; 4,210,584; 4,215,062; 4,250,189; 4,258,052;
4,259,242; 4,296,105; 4,299,778; 4,367,239; 4,374,414; 4,375,432;
4,472,379; 4,588,831; 4,639,456; 4,767,855; 4,828,831; 4,841,045;
4,841,085; 4,908,356; 4,923,876; 5,030,620; 5,034,320; 5,047,528;
5,066,658; 5,166,149; 5,190,929; 5,215,738; 5,292,731; 5,380,897;
5,382,582; 5,409,915; 5,440,056; 5,446,139; 5,472,956; 5,527,905;
5,552,156; 5,594,158; 5,602,140; 5,665,768; 5,843,903; 6,080,874;
6,096,923; and U.S. Pat. No. RE030561.
[0282] In another embodiment, the cell-cycle inhibitor is
camptothecin, mitoxantrone, etoposide, 5-fluorouracil, doxorubicin,
methotrexate, peloruside A, mitomycin C, or a CDK-2 inhibitor or an
analogue or derivative of any member of the class of listed
compounds.
[0283] In another embodiment, the cell-cycle inhibitor is HTI-286,
plicamycin; or mithramycin, or an analogue or derivative
thereof.
[0284] Other examples of cell cycle inhibitors also include, e.g.,
7-hexanoyltaxol (QP-2), cytochalasin A, lantrunculin D,
actinomycin-D, Ro-31-7453
(3-(6-nitro-1-methyl-3-indolyl)-4-(1-methyl-3-indolyl)pyrrole--
2,5-dione), PNU-151807, brostallicin, C2-ceramide, cytarabine
ocfosfate (2(1H)-pyrimidinone,
4-amino-1-(5-O-(hydroxy(octadecyloxy)phosphinyl)-.be-
ta.-D-arabinofuranosyl)-, monosodium salt), paclitaxel
(5.beta.,20-epoxy-1,2 alpha,4,7.beta.,10.beta.,13
alpha-hexahydroxytax-11-
-en-9-one-4,10-diacetate-2-benzoate-13-(alpha-phenylhippurate)),
doxorubicin (5,12-naphthacenedione,
10-((3-amino-2,3,6-trideoxy-alpha-L-l-
yxo-hexopyranosyl)oxy)-7,8,9,10-tetrahydro-6,8,11-trihydroxy-8-(hydroxyace-
tyl)-1-methoxy-, (8S)-cis-), daunorubicin (5,12-naphthacenedione,
8-acetyl-10-((3-amino-2,3,6-trideoxy-alpha-L-lyxo-hexopyranosyl)oxy)-7,8,-
9,10-tetrahydro-6,8,11-trihydroxy-1-methoxy-, (8S-cis)-),
gemcitabine hydrochloride (cytidine,
2'-deoxy-2',2'-difluoro-,monohydrochloride), nitacrine
(1,3-propanediamine, N,N-dimethyl-N'-(1-nitro-9-acridinyl)-),
carboplatin (platinum, diammine(1,1-cyclobutanedicarboxylato(2-))-,
(SP-4-2)-), altretamine (1,3,5-triazine-2,4,6-triamine,
N,N,N',N',N",N"-hexamethyl-), teniposide
(furo(3',4':6,7)naphtho(2,3-d )-1,3-dioxol-6(5aH)-one,
5,8,8a,9-tetrahydro-5-(4-hydroxy-3,5-dimethoxyph-
enyl)-9-((4,6-O-(2-thienylmethylene)-.beta.-D-glucopyranosyl)oxy)-,
(5R-(5alpha,5a.beta.,8aAlpha,9.beta.(R*)))-), eptaplatin (platinum,
((4R,5R)-2-(1-methylethyl)-1,3-dioxolane-4,5-dimethanamine-kappa
N4,kappa N5)(propanedioato(2-)-kappa O1, kappa O3)-, (SP-4-2)-),
amrubicin hydrochloride (5,12-naphthacenedione,
9-acetyl-9-amino-7-((2-deoxy-.beta.-
-D-erythro-pentopyranosyl)oxy)-7,8,9,10-tetrahydro-6,11-dihydroxy-,
hydrochloride, (7S-cis)-), ifosfamide
(2H-1,3,2-oxazaphosphorin-2-amine,
N,3-bis(2-chloroethyl)tetrahydro-2-oxide), cladribine (adenosine,
2-chloro-2'-deoxy-), mitobronitol (D-mannitol,
1,6-dibromo-1,6-dideoxy-), fludaribine phosphate (9H-purin-6-amine,
2-fluoro-9-(5-O-phosphono-.beta.- -D-arabinofuranosyl)-),
enocitabine (docosanamide, N-(1-.beta.-D-arabinofu-
ranosyl-1,2-dihydro-2-oxo-4-pyrimidinyl)-), vindesine
(vincaleukoblastine,
3-(aminocarbonyl)-O4-deacetyl-3-de(methoxycarbonyl)-), idarubicin
(5,12-naphthacenedione,
9-acetyl-7-((3-amino-2,3,6-trideoxy-alpha-L-lyxo--
hexopyranosyl)oxy)-7,8,9,10-tetrahydro-6,9,11-trihydroxy-,
(7S-cis)-), zinostatin (neocarzinostatin), vincristine
(vincaleukoblastine, 22-oxo-), tegafur (2,4(1H,3H)-pyrimidinedione,
5-fluoro-1-(tetrahydro-2-furanyl)-), razoxane (2,6-piperazinedione,
4,4'-(1-methyl-1,2-ethanediyl)bis-), methotrexate (L-glutamic acid,
N-(4-(((2,4-diamino-6-pteridinyl)methyl)me- thylamino)benzoyl)-),
raltitrexed (L-glutamic acid,
N-((5-(((1,4-dihydro-2-methyl-4-oxo-6-quinazolinyl)methyl)methylamino)-2--
thienyl)carbonyl)-), oxaliplatin (platinum,
(1,2-cyclohexanediamine-N,N')(- ethanedioato(2-)-O,O')-,
(SP-4-2-(1R-trans))-), doxifluridine (uridine, 5'-deoxy-5-fluoro-),
mitolactol (galactitol, 1,6-dibromo-1,6-dideoxy-), piraubicin
(5,12-naphthacenedione, 10-((3-amino-2,3,6-trideoxy-4-O-(tetra-
hydro-2H-pyran-2-yl)-alpha-L-lyxo-hexopyranosyl)oxy)-7,8,9,10-tetrahydro-6-
,8,11-trihydroxy-8-(hydroxyacetyl)-1-methoxy-, (8S-(8 alpha, 10
alpha(S*)))-), docetaxel ((2R,3S)-N-carboxy-3-phenylisoserine,
N-tert-butyl ester, 13-ester with 5.beta.,20-epoxy-1,2
alpha,4,7.beta.,10.beta.,13 alpha-hexahydroxytax-11-en-9-one
4-acetate 2-benzoate-), capecitabine (cytidine,
5-deoxy-5-fluoro-N-((pentyloxy)carb- onyl)-), cytarabine
(2(1H)-pyrimidone, 4-amino-1-.beta.-D-arabino furanosyl-),
valrubicin (pentanoic acid, 2-(1,2,3,4,6,11-hexahydro-2,5,12-
-trihydroxy-7-methoxy-6,11-dioxo-4-((2,3,6-trideoxy-3-((trifluoroacetyl)am-
ino)-alpha-L-lyxo-hexopyranosyl)oxy)-2-naphthacenyl)-2-oxoethyl
ester (2S-cis)-), trofosfamide
(3-2-(chloroethyl)-2-(bis(2-chloroethyl)amino)te-
trahydro-2H-1,3,2-oxazaphosphorin 2-oxide), prednimustine
(pregna-1,4-diene-3,20-dione,
21-(4-(4-(bis(2-chloroethyl)amino)phenyl)-1-
-oxobutoxy)-11,17-dihydroxy-, (11.beta.)-), lomustine (Urea,
N-(2-chloroethyl)-N'-cyclohexyl-N-nitroso-), epirubicin
(5,12-naphthacenedione,
10-((3-amino-2,3,6-trideoxy-alpha-L-arabino-hexop-
yranosyl)oxy)-7,8,9,10-tetrahydro-6,8,11-trihydroxy-8-(hydroxyacetyl)-1-me-
thoxy-, (8S-cis)-), or an analogue or derivative thereof).
[0285] 5) Cyclin Dependent Protein Kinase Inhibitors
[0286] In another embodiment, the pharmacologically active compound
is a cyclin dependent protein kinase inhibitor (e.g.,
R-roscovitine, CYC-101, CYC-103, CYC-400, MX-7065, alvocidib
(4H-1-Benzopyran-4-one,
2-(2-chlorophenyl)-5,7-dihydroxy-8-(3-hydroxy-1-methyl-4-piperidinyl)-,
cis-(-)-), SU-9516, AG-12275, PD-0166285, CGP-79807, fascaplysin,
GW-8510 (benzenesulfonamide,
4-(((Z)-(6,7-dihydro-7-oxo-8H-pyrrolo(2,3-g)benzothi-
azol-8-ylidene)methyl)amino)-N-(3-hydroxy-2,2-dimethylpropyl)-),
GW-491619, Indirubin 3' monoxime, GW8510, AZD-5438, ZK-CDK or an
analogue or derivative thereof).
[0287] 6) EGF (Epidermal Growth Factor) Receptor Kinase
Inhibitors
[0288] In another embodiment, the pharmacologically active compound
is an EGF (epidermal growth factor) kinase inhibitor (e.g.,
erlotinib (4-quinazolinamine,
N-(3-ethynylphenyl)-6,7-bis(2-methoxyethoxy)-, monohydrochloride),
erbstatin, BIBX-1382, gefitinib (4-quinazolinamine,
N-(3-chloro-4-fluorophenyl)-7-methoxy-6-(3-(4-morpholinyl)propoxy)),
or an analogue or derivative thereof).
[0289] 7) Elastase Inhibitors
[0290] In another embodiment, the pharmacologically active compound
is an elastase inhibitor (e.g., ONO-6818, sivelestat sodium hydrate
(glycine,
N-(2-(((4-(2,2-dimethyl-1-oxopropoxy)phenyl)sulfonyl)amino)benzoyl)-),
erdosteine (acetic acid,
((2-oxo-2-((tetrahydro-2-oxo-3-thienyl)amino)eth- yl)thio)-),
MDL-100948A, MDL-104238 (N-(4-(4-morpholinylcarbonyl)benzoyl)--
L-valyl-N'-(3,3,4,4,4-pentafluoro-1-(1-methylethyl)-2-oxobutyl)-L-2-azetam-
ide), MDL-27324 (L-prolinamide,
N-((5-(dimethylamino)-1-naphthalenyl)sulfo-
nyl)-L-alanyl-L-alanyl-N-(3,3,3-trifluoro-1-(1-methylethyl)-2-oxopropyl)-,
(S)-), SR-26831 (thieno(3,2-c)pyridinium,
5-((2-chlorophenyl)methyl)-2-(2-
,2-dimethyl-1-oxopropoxy)-4,5,6,7-tetrahydro-5-hydroxy-),
Win-68794, Win-63110, SSR-69071
(2-(9(2-piperidinoethoxy)-4-oxo-4H-pyrido(1,2-a
)pyrimidin-2-yloxymethyl)-4-(1-methylethyl)-6-methyoxy-1,2-benzisothiazol-
-3(2H )-one-1,1-dioxide),
(N(Alpha)-(1-adamantylsulfonyl)N(epsilon)-succin-
yl-L-lysyl-L-prolyl-L-valinal), Ro-31-3537 (N
alpha-(1-adamantanesulphonyl-
)-N-(4-carboxybenzoyl)-L-lysyl-alanyl-L-valinal), R-665, FCE-28204,
((6R,7R)-2-(benzoyloxy)-7-methoxy-3-methyl-4-pivaloyl-3-cephem
1,1-dioxide), 1,2-benzisothiazol-3(2H)-one, 2-(2,4-dinitrophenyl)-,
1,1-dioxide, L-658758 (L-proline,
1-((3-((acetyloxy)methyl)-7-methoxy-8-o-
xo-5-thia-1-azabicyclo(4.2.0)oct-2-en-2-yl)carbonyl)-, S,S-dioxide,
(6R-cis)-), L-659286 (pyrrolidine,
1-((7-methoxy-8-oxo-3-(((1,2,5,6-tetra
hydro-2-methyl-5,6-dioxo-1,2,4-triazin-3-yl
)thio)methyl)-5-thia-1-azabic- yclo(4.2.0)oct-2-en-2-yl)carbonyl)-,
S,S-dioxide, (6R-cis)-), L-680833 (benzeneacetic acid,
4-((3,3-diethyl-1-(((1-(4-methylphenyl)butyl)amino)c-
arbonyl)-4-oxo-2-azetidinyl)oxy)-, (S-(R*,S*))-), FK-706
(L-prolinamide,
N-[4-[[(carboxymethyl)amino]carbonyl]benzoyl]-L-valyl-N-[3,3,3-trifluoro--
1-(1-methylethyl)-2-oxopropyl]-, monosodium salt), Roche R-665, or
an analogue or derivative thereof).
[0291] 8) Factor Xa Inhibitors
[0292] In another embodiment, the pharmacologically active compound
is a factor Xa inhibitor (e.g., CY-222, fondaparinux sodium
(alpha-D-glucopyranoside, methyl
O-2-deoxy-6-O-sulfo-2-(sulfoamino)-alpha-
-D-glucopyranosyl-(1-4)-O-.beta.-D-glucopyranuronosyl-(1-4)-O-2-deoxy-3,6--
di-O-sulfo-2-(sulfoamino)-alpha-D-glucopyranosyl-(1-4)-O-2-O-sulfo-alpha-L-
-idopyranuronosyl-(1-4)-2-deoxy-2-(sulfoamino)-, 6-(hydrogen
sulfate)), danaparoid sodium, or an analogue or derivative
thereof).
[0293] 9) Famesyltransferase Inhibitors
[0294] In another embodiment, the pharmacologically active compound
is a farnesyltransferase inhibitor (e.g., dichlorobenzoprim
(2,4-diamino-5-(4-(3,4-dichlorobenzylamino)-3-nitrophenyl)-6-ethylpyrimid-
ine), B-581, B-956
(N-(8(R)-amino-2(S)-benzyl-5(S)-isopropyl-9-sulfanyl-3(-
Z),6(E)-nonadienoyl)-L-methionine), OSI-754, perillyl alcohol
(1-cyclohexene-1-methanol, 4-(1-methylethenyl)-, RPR-114334,
lonafarnib (1-piperidinecarboxamide,
4-(2-(4-((11R)-3,10-dibromo-8-chloro-6,11-dihyd-
ro-5H-benzo(5,6)cyclohepta(1,2-b)pyridin-11-yl)-1-piperidinyl)-2-oxoethyl)-
-), Sch-48755, Sch-226374,
(7,8-dichloro-5H-dibenzo(b,e)(1,4)diazepin-11-y-
l)-pyridin-3-ylmethylamine, J-104126, L-639749, L-731734
(pentanamide,
2-((2-((2-amino-3-mercaptopropyl)amino)-3-methylpentyl)amino)-3-methyl-N--
(tetrahydro-2-oxo-3-furanyl)-, (3S-(3R*(2R*(2R*(S*),3S*),3R*)))-),
L-744832 (butanoic acid,
2-((2-((2-((2-amino-3-mercaptopropyl)amino)-3-me-
thylpentyl)oxy)-1-oxo-3-phenylpropyl)amino)-4-(methylsulfonyl)-,
1-methylethyl ester, (2S-(1(R*(R*)),2R*(S*),3R*))-), L-745631
(1-piperazinepropanethiol,
.beta.-amino-2-(2-methoxyethyl)-4-(1-naphthale- nylcarbonyl)-,
(.beta.R,2S)-), N-acetyl-N-naphthylmethyl-2(S)-((1-(4-cyano-
benzyl)-1H-imidazol-5-yl)acetyl)amino-3(S)-methylpentamine,
(2alpha)-2-hydroxy-24,25-dihydroxylanost-8-en-3-one, BMS-316810,
UCF-1-C (2,4-decadienamide,
N-(5-hydroxy-5-(7-((2-hydroxy-5-oxo-1-cyclopenten-1-y-
l)amino-oxo-1,3,5-heptatrienyl)-2-oxo-7-oxabicyclo(4.1.0)hept-3-en-3-yl)-2-
,4,6-trimethyl-, (1S-(1alpha,3(2E,4E,6S*),5 alpha, 5(1E,3E,5E), 6
alpha))-), UCF-116-B, ARGLABIN
(3H-oxireno[8,8a]azuleno[4,5-b]furan-8(4aH- )-one,
5,6,6a,7,9a,9b-hexahydro-1,4a-dimethyl-7-methylene-, (3aR,4aS
,6aS,9aS ,9bR)-) from ARGLABIN--Paracure, Inc. (Virginia Beach,
Va.), or an analogue or derivative thereof).
[0295] 10) Fibrinogen Antagonists
[0296] In another embodiment, the pharmacologically active compound
is a fibrinogen antagonist (e.g.,
2(S)-((p-toluenesulfonyl)amino)-3-(((5,6,7,8-
,-tetrahydro-4-oxo-5-(2-(piperidin-4-yl)ethyl)-4H-pyrazolo-(1,5-a)(1,4)dia-
zepin-2-yl)carbonyl)-amino)propionic acid, streptokinase (kinase
(enzyme-activating), strepto-), urokinase (kinase
(enzyme-activating), uro-), plasminogen activator, pamiteplase,
monteplase, heberkinase, anistreplase, alteplase, pro-urokinase,
picotamide (1,3-benzenedicarboxamide,
4-methoxy-N,N'-bis(3-pyridinylmethyl)-), or an analogue or
derivative thereof).
[0297] 11) Guanylate Cyclase Stimulants
[0298] In another embodiment, the pharmacologically active compound
is a guanylate cyclase stimulant (e.g., isosorbide-5-mononitrate
(D-glucitol, 1,4:3,6-dianhydro-, 5-nitrate), or an analogue or
derivative thereof).
[0299] 12) Heat Shock Protein 90 Antagonists
[0300] In another embodiment, the pharmacologically active compound
is a heat shock protein 90 antagonist (e.g., geldanamycin;
NSC-33050 (17-allylaminogeldanamycin), rifabutin (rifamycin XIV,
1',4-didehydro-1-deoxy-1,4-dihydro-5'-(2-methylpropyl)-1-oxo-),
17AAG, or an analogue or derivative thereof).
[0301] 13) HMGCoA Reductase Inhibitors
[0302] In another embodiment, the pharmacologically active compound
is an HMGCoA reductase inhibitor (e.g., BCP-671, BB-476,
fluvastatin (6-heptenoic acid,
7-(3-(4-fluorophenyl)-1-(1-methylethyl)-1H-indol-2-yl)-
-3,5-dihydroxy-, monosodium salt, (R*,S*-(E))-(.+-.)-), dalvastatin
(2H-pyran-2-one,
6-(2-(2-(2-(4-fluoro-3-methylphenyl)-4,4,6,6-tetramethyl-
-1-cyclohexen-1-yl)ethenyl)tetrahydro)-4-hydroxy-,
(4alpha,6.beta.(E))-(.+- -.)-), glenvastatin (2H-pyran-2-one,
6-(2-(4-(4-fluorophenyl)-2-(1-methyle-
thyl)-6-phenyl-3-pyridinyl)ethenyl)tetrahydro-4-hydroxy-,
(4R-(4alpha,6.beta.(E)))-), S-2468, N-(1-oxododecyl)-4Alpha,
10-dimethyl-8-aza-trans-decal-3.beta.-ol, atorvastatin calcium
(1H-Pyrrole-1-heptanoic acid,
2-(4-fluorophenyl)-.beta.,delta-dihydroxy-5-
-(1-methylethyl)-3-phenyl-4-((phenylamino)carbonyl)-, calcium salt
(R-(R*,R*))-), CP-83101 (6,8-nonadienoic acid,
3,5-dihydroxy-9,9-diphenyl- -, methyl ester, (R*,S*-(E))-(.+-.)-),
pravastatin (1-naphthaleneheptanoic acid,
1,2,6,7,8,8a-hexahydro-.beta.,delta,6-trihydroxy-2-methyl-8-(2-meth-
yl-1-oxobutoxy)-, monosodium salt, (1S-(1alpha(.beta.S*,deltaS*),2
alpha,6 alpha,8.beta.(R*),8a alpha))-), U-20685, pitavastatin
(6-heptenoic acid,
7-(2-cyclopropyl-4-(4-fluorophenyl)-3-quinolinyl)-3,5-dihydroxy-,
calcium salt (2:1), (S-(R*,S*-(E)))-),
N-((1-methylpropyl)carbonyl)-8-(2-(tetrahy-
dro-4-hydroxy-6-oxo-2H-pyran-2-yl)ethyl)-perhydro-isoquinoline,
dihydromevinolin (butanoic acid,
2-methyl-,1,2,3,4,4a,7,8,8a-octahydro-3,-
7-dimethyl-8-(2-(tetrahydro-4-hydroxy-6-oxo-2H-pyran-2-yl)ethyl)-1-naphtha-
lenyl ester(1 alpha(R*), 3 alpha, 4a
alpha,7.beta.,8.beta.(2S*,4S*),8a.bet- a.))-), HBS-107,
dihydromevinolin (butanoic acid, 2-methyl-,
1,2,3,4,4a,7,8,8a-octahydro-3,7-dimethyl-8-(2-(tetrahydro-4-hydroxy-6-oxo-
-2H-pyran-2-yl)ethyl)-1-naphthalenyl ester(1 alpha(R*), 3 alpha,4a
alpha,7.beta.,8.beta.(2S*,4S*),8a.beta.))-), L-669262 (butanoic
acid, 2,2-dimethyl-,
1,2,6,7,8,8a-hexahydro-3,7-dimethyl-6-oxo-8-(2-(tetrahydro-
-4-hydroxy-6-oxo-2H-pyran-2-yl)ethyl)-1-naphthalenyl(1S-(1Alpha,7.beta.,8.-
beta.(2S*,4S*),8a.beta.))-), simvastatin (butanoic acid,
2,2-dimethyl-,
1,2,3,7,8,8a-hexahydro-3,7-dimethyl-8-(2-(tetrahydro-4-hydroxy-6-oxo-2H-p-
yran-2-yl)ethyl)-1-naphthalenyl ester, (1S-(1alpha,
3alpha,7.beta.,8.beta.(2S*,4S*),8a.beta.))-), rosuvastatin calcium
(6-heptenoic acid,
7-(4-(4-fluorophenyl)-6-(1-methylethyl)-2-(methyl(meth-
ylsulfonyl)amino)-5-pyrimdinyl)-3,5-dihydroxy-calcium salt (2:1)
(S-(R*, S*-(E)))), meglutol
(2-hydroxy-2-methyl-1,3-propandicarboxylic acid), lovastatin
(butanoic acid, 2-methyl-, 1,2,3,7,8,8a-hexahydro-3,7-dimethyl-
-8-(2-(tetrahydro-4-hydroxy-6-oxo-2H-pyran-2-yl)ethyl)-1-naphthalenyl
ester, (1S-(1 alpha.(R*),3
alpha,7.beta.,8.beta.(2S*,4S*),8a.beta.))-), or an analogue or
derivative thereof).
[0303] 14) Hydroorotate Dehydrogenase Inhibitors
[0304] In another embodiment, the pharmacologically active compound
is a hydroorotate dehydrogenase inhibitor (e.g., leflunomide
(4-isoxazolecarboxamide, 5-methyl-N-(4-(trifluoromethyl)phenyl)-),
laflunimus (2-propenamide,
2-cyano-3-cyclopropyl-3-hydroxy-N-(3-methyl-4(-
trifluoromethyl)phenyl)-, (Z)-), or atovaquone
(1,4-naphthalenedione, 2-[4-(4-chlorophenyl)cyclohexyl]-3-hydroxy-,
trans-, or an analogue or derivative thereof).
[0305] 15) IKK2 Inhibitors
[0306] In another embodiment, the pharmacologically active compound
is an IKK2 inhibitor (e.g., MLN-120B, SPC-839, or an analogue or
derivative thereof).
[0307] 16) IL-1. ICE and IRAK Antagonists
[0308] In another embodiment, the pharmacologically active compound
is an IL-1, ICE or an IRAK antagonist (e.g., E-5090 (2-propenoic
acid, 3-(5-ethyl-4-hydroxy-3-methoxy-1-naphthalenyl)-2-methyl-,
(Z)-), CH-164, CH-172, CH-490, AMG-719, iguratimod
(N-(3-(formylamino)-4-oxo-6-phenoxy-4- H-chromen-7-yl)
methanesulfonamide), AV94-88, pralnacasan
(6H-pyridazino(1,2-a)(1,2)diazepine-1-carboxamide,
N-((2R,3S)-2-ethoxytetrahydro-5-oxo-3-furanyl)octahydro-9-((1-isoquinolin-
ylcarbonyl)amino)-6,10-dioxo-, (1S,9S)-),
(2S-cis)-5-(benzyloxycarbonylami-
no-1,2,4,5,6,7-hexahydro-4-(oxoazepino(3,2,1-hi)indole-2-carbonyl)-amino)--
4-oxobutanoic acid, AVE-9488, esonarimod (benzenebutanoic acid,
alpha-((acetylthio)methyl)4-methyl-gamma-oxo-), pralnacasan
(6H-pyridazino(1,2-a)(1,2)diazepine-1-carboxamide,
N-((2R,3S)-2-ethoxytetrahydro-5-oxo-3-furanyl)octahydro-9-((1-isoquinolin-
ylcarbonyl)amino)-6,10-dioxo-, (1S,9S)-), tranexamic acid
(cyclohexanecarboxylic acid, 4-(aminomethyl)-, trans-), Win-72052,
romazarit (Ro-31-3948) (propanoic acid,
2-((2-(4-chlorophenyl)-4-methyl-5- -oxazolyl)methoxy)-2-methyl-),
PD-163594, SDZ-224-015 (L-alaninamide
N-((phenylmethoxy)carbonyl)-L-valyl-N-((1
S)-3-((2,6-dichlorobenzoyl)oxy)-
-1-(2-ethoxy-2-oxoethyl)-2-oxopropyl)-), L-709049 (L-alaninamide,
N-acetyl-L-tyrosyl-L-valyl-N-(2-carboxy-1-formylethyl)-, (S)-),
TA-383 (1H-imidazole, 2-(4-chlorophenyl)-4,5-dihydro-4,5-diphenyl-,
monohydrochloride, cis-), EI-1507-1
(6a,12a-epoxybenz(a)anthracen-1,12(2H ,7H)-dione,
3,4-dihydro-3,7-dihydroxy-8-methoxy-3-methyl-), ethyl
4-(3,4-dimethoxyphenyl)-6,7-dimethoxy-2-(1,2,4-triazol-1-yl
methyl)quinoline-3-carboxylate, EI-1941-1, TJ-114, anakinra
(interleukin 1 receptor antagonist (human isoform .times. reduced),
N2-L-methionyl-), IX-207-887 (acetic acid,
(10-methoxy-4H-benzo[4,5]cyclohepta[1,2-b]thien-- 4-ylidene)-),
K-832, or an analogue or derivative thereof).
[0309] 17) IL-4 Agonists
[0310] In another embodiment, the pharmacologically active compound
is an IL-4 agonist (e.g., glatiramir acetate (L-glutamic acid,
polymer with L-alanine, L-lysine and L-tyrosine, acetate (salt)),
or an analogue or derivative thereof).
[0311] 18) Immunomodulatory Agents
[0312] In another embodiment, the pharmacologically active compound
is an immunomodulatory agent (e.g., biolimus, ABT-578,
methylsulfamic acid
3-(2-methoxyphenoxy)-2-(((methylamino)sulfonyl)oxy)propyl ester,
sirolimus (also referred to as rapamycin or RAPAMUNE (American Home
Products, Inc., Madison, N.J.)), CCI-779 (rapamycin
42-(3-hydroxy-2-(hydroxymethyl)-2-methylpropanoate)), LF-15-0195,
NPC15669 (L-leucine,
N-(((2,7-dimethyl-9H-fluoren-9-yl)methoxy)carbonyl)-- ), NPC-15670
(L-leucine, N-(((4,5-dimethyl-9H-fluoren-9-yl)methoxy)carbony-
l)-), NPC-16570 (4-(2-(fluoren-9-yl)ethyloxy-carbonyl)aminobenzoic
acid), sufosfamide (ethanol,
2-((3-(2-chloroethyl)tetrahydro-2H-1,3,2-oxazaphosp-
horin-2-yl)amino)-, methanesulfonate (ester), P-oxide), tresperimus
(2-(N-(4-(3-aminopropylamino)butyl)carbamoyloxy)-N-(6-guanidinohexyl)acet-
amide), 4-(2-(fluoren-9-yl)ethoxycarbonylamino)-benzo-hydroxamic
acid, iaquinimod, PBI-1411, azathioprine
(6-((1-Methyl-4-nitro-1H-imidazol-5-yl- )thio)-1H-purine), PBI0032,
beclometasone, MDL-28842 (9H-purin-6-amine,
9-(5-deoxy-5-fluoro-.beta.-D-threo-pent-4-enofuranosyl)-, (Z)-),
FK-788, AVE-1726, ZK-90695, ZK-90695, Ro-54864, didemnin-B,
Illinois (didemnin A, N-(1-(2-hydroxy-1-oxopropyl)-L-prolyl)-,
(S)-), SDZ-62-826 (ethanaminium,
2-((hydroxy((1-((octadecyloxy)carbonyl)-3-piperidinyl)methoxy)phosphinyl)-
oxy)-N,N,N-trimethyl-, inner salt), argyrin B
((4S,7S,13R,22R)-13-Ethyl-4--
(1H-indol-3-ylmethyl)-7-(4-methoxy-1H-indol-3-ylmethyl)18,22-dimethyl-16-m-
ethyl-ene-24-thia-3,6,9,12,15,18,21,26-octaazabicyclo(21.2.1)-hexacosa-1(2-
5),23(26)-diene-2,5,8,11,14,17,20-heptaone), everolimus (rapamycin,
42-O-(2-hydroxyethyl)-), SAR-943, L-687795,
6-((4-chlorophenyl)sulfinyl)--
2,3-dihydro-2-(4-methoxy-phenyl)-5-methyl-3-oxo-4-pyridazinecarbonitrile,
91 Y78 (1H-imidazo(4,5-c)pyridin-4-amine,
1-.beta.-D-ribofuranosyl-), auranofin (gold,
(1-thio-.beta.-D-glucopyranose 2,3,4,6-tetraacetato-S)(t-
riethylphosphine)), 27-O-demethylrapamycin, tipredane
(androsta-1,4-dien-3-one,
17-(ethylthio)-9-fluoro-11-hydroxy-17-(methylth- io)-, (11.beta.,17
alpha)-), AI-402, LY-178002 (4-thiazolidinone,
5-((3,5-bis(1,1-dimethylethyl)-4-hydroxyphenyl)methylene)-),
SM-8849 (2-thiazolamine,
4-(1-(2-fluoro(1,1'-biphenyl)-4-yl)ethyl)-N-methyl-), piceatannol,
resveratrol, triamcinolone acetonide (pregna-1,4-diene-3,20--
dione,
9-fluoro-11,21-dihydroxy-16,17-((1-methylethylidene)bis(oxy))-,
(11.beta.,16 alpha)-), ciclosporin (cyclosporin A), tacrolimus
(15,19-epoxy-3H-pyrido(2,1-c)(1,4)oxaazacyclotricosine-1,7,20,21
(4H,23H)-tetrone,
5,6,8,11,12,13,14,15,16,17,18,19,24,25,26,26a-hexadecah-
ydro-5,19-dihydroxy-3-(2-(4-hydroxy-3-methoxycyclohexyl)-1-methylethenyl)--
14,16-dimethoxy-4,10,12,18-tetramethyl-8-(2-propenyl)-,
(3S-(3R*(E(1S*,3S*,4S*)),4S*,5R*,8S*,9E,12R*,14R*,15S*,16R*,18S*,19S*,26a-
R*))-), gusperimus (heptanamide,
7-((aminoiminomethyl)amino)-N-(2-((4-((3--
aminopropyl)amino)butyl)amino)-1-hydroxy-2-oxoethyl)-, (.+-.)-),
tixocortol pivalate (pregn-4-ene-3,20-dione,
21-((2,2-dimethyl-1-oxopropy- l)thio)-11,17-dihydroxy-,
(11.beta.)-), alefacept (1-92 LFA-3 (antigen) (human) fusion
protein with immunoglobulin G1 (human hinge-CH2-CH3 gamma1-chain),
dimer), halobetasol propionate (pregna-1,4-diene-3,20-dion- e,
21-chloro-6,9-difluoro-11-hydroxy-16-methyl-17-(1-oxopropoxy)-,
(6A-pha,11.beta.16.beta.)-), iloprost trometamol (pentanoic acid,
5-(hexahydro-5-hydroxy-4-(3-hydroxy-4-methyl-1-octen-6-ynyl)-2(1H)-pental-
enylidene)-), beraprost (1H-cyclopenta(b)benzofuran-5-butanoic
acid,
2,3,3a,8b-tetrahydro-2-hydroxy-1-(3-hydroxy-4-methyl-1-octen-6-ynyl)-),
rimexolone (androsta-1,4-dien-3-one,
11-hydroxy-16,17-dimethyl-17-(1-oxop- ropyl)-, (11.beta.,16Alpha,
17.beta.)-), dexamethasone
(pregna-1,4-diene-3,20-dione,9-fluoro-11,17,21-trihydroxy-16-methyl-,
(11.beta., 16alpha)-), sulindac
(cis-5-fluoro-2-methyl-1-((p-methylsulfin-
yl)benzylidene)indene-3-acetic acid), proglumetacin
(1H-Indole-3-acetic acid, 1-(4-chlorobenzoyl)-5-methoxy-2-methyl-,
2-(4-(3-((4-(benzoylamino)-
-5-(dipropylamino)-1,5-dioxopentyl)oxy)propyl)-1-piperazinyl)ethylester,
(.+-.)-), alclometasone dipropionate (pregna-1,4-diene-3,20-dione,
7-chloro-11-hydroxy-16-methyl-17,21-bis(1-oxopropoxy)-,
(7alpha,11.beta., 16alpha)-), pimecrolimus
(15,19-epoxy-3H-pyrido(2,1-c)(1,4)oxaazacyclotri-
cosine-1,7,20,21(4H ,23H)-tetrone,
3-(2-(4-chloro-3-methoxycyclohexyl)-1-m-
ethyletheny)-8-ethyl-5,6,8,11,12,13,14,15,16,17,18,19,24,25,26,26a-hexadec-
ahydro-5,19-dihydroxy-14,16-dimethoxy-4,10,12,18-tetramethyl-,
(3S-(3R*(E(1S*,3S*,4R*)),4S*,5R*,8S*,9E,12R*,14R*,15S*,16R*,18S,
19S*,26aR*))-), hydrocortisone-17-butyrate (pregn-4-ene-3,20-dione,
11,21-dihydroxy-17-(1-oxobutoxy)-, (11.beta.)-), mitoxantrone
(9,10-anthracenedione,
1,4-dihydroxy-5,8-bis((2-((2-hydroxyethyl)amino)et- hyl)amino)-),
mizoribine (1H-imidazole-4-carboxamide,
5-hydroxy-1-.beta.-D-ribofuranosyl-), prednicarbate
(pregna-1,4-diene-3,20-dione,
17-((ethoxycarbonyl)oxy)-11-hydroxy-21-(1-o- xopropoxy)-,
(11.beta.)-), iobenzarit (benzoic acid,
2-((2-carboxyphenyl)amino)-4-chloro-), glucametacin (D-glucose,
2-(((1-(4-chlorobenzoyl)-5-methoxy-2-methyl-1H-indol-3-yl)acetyl)amino)-2-
-deoxy-), fluocortolone monohydrate ((6
alpha)-fluoro-16alpha-methylpregna-
-1,4-dien-11.beta.,21-diol-3,20-dione), fluocortin butyl
(pregna-1,4-dien-21-oic acid,
6-fluoro-11-hydroxy-16-methyl-3,20-dioxo-, butyl ester, (6alpha,
11.beta., 16alpha)-), difluprednate (pregna-1,4-diene-3,20-dione,
21-(acetyloxy)-6,9-difluoro-11-hydroxy-17-(- 1-oxobutoxy)-, (6
alpha, 11.beta.)-), diflorasone diacetate
(pregna-1,4-diene-3,20-dione,
17,21-bis(acetyloxy)-6,9-difluoro-11-hydrox- y-16-methyl-, (6Alpha,
11.beta.,16.beta.)-), dexamethasone valerate
(pregna-1,4-diene-3,20-dione,
9-fluoro-11,21-dihydroxy-16-methyl-17-((1-o- xopentyl)oxy)-,
(11.beta.,16Alpha)-), methylprednisolone, deprodone propionate
(pregna-1,4-diene-3,20-dione, 11-hydroxy-17-(1-oxopropoxy),
(11.beta.)-), bucillamine (L-cysteine,
N-(2-mercapto-2-methyl-1-oxopropyl- )-), amcinonide (benzeneacetic
acid, 2-amino-3-benzoyl-, monosodium salt, monohydrate), acemetacin
(1H-indole-3-acetic acid, 1-(4-chlorobenzoyl)-5-methoxy-2-methyl-,
carboxymethyl ester), or an analogue or derivative thereof).
[0313] Further, analogues of rapamycin include tacrolimus and
derivatives thereof (e.g., EP0184162B1 and U.S. Pat. No. 6,258,823)
everolimus and derivatives thereof (e.g., U.S. Pat. No. 5,665,772).
Further representative examples of sirolimus analogues and
derivatives can be found in PCT Publication Nos. WO 97/10502, WO
96/41807, WO 96/35423, WO 96/03430, WO 96/00282, WO 95/16691, WO
95/15328, WO 95/07468, WO 95/04738, WO 95/04060, WO 94/25022, WO
94/21644, WO 94/18207, WO 94/10843, WO 94/09010, WO 94/04540, WO
94/02485, WO 94/02137, WO 94/02136, WO 93/25533, WO 93/18043, WO
93/13663, WO 93/11130, WO 93/10122, WO 93/04680, WO 92/14737, and
WO 92/05179. Representative U.S. patents include U.S. Pat. Nos.
6,342,507; 5,985,890; 5,604,234; 5,597,715; 5,583,139; 5,563,172;
5,561,228; 5,561,137; 5,541,193; 5,541,189; 5,534,632; 5,527,907;
5,484,799; 5,457,194; 5,457,182; 5,362,735; 5,324,644; 5,318,895;
5,310,903; 5,310,901; 5,258,389; 5,252,732; 5,247,076; 5,225,403;
5,221,625; 5,210,030; 5,208,241; 5,200,411; 5,198,421; 5,147,877;
5,140,018; 5,116,756; 5,109,112; 5,093,338; and 5,091,389.
[0314] The structures of sirolimus, everolimus, and tacrolimus are
provided below:
22 Name Code Name Company Structure Everolimus SAR-943 Novartis See
below Sirolimus AY-22989 Wyeth See below RAPAMUNE NSC-226080
Rapamycin Tacrolimus FK506 Fujusawa See below 79 80 81
[0315] Further sirolimus analogues and derivatives include
tacrolimus and derivatives thereof (e.g., EP0184162B1 and U.S. Pat.
No. 6,258,823) everolimus and derivatives thereof (e.g., U.S. Pat.
No. 5,665,772). Further representative examples of sirolimus
analogues and derivatives include ABT-578 and others may be found
in PCT Publication Nos. WO 97/10502, WO 96/41807, WO 96/35423, WO
96/03430, WO 9600282, WO 95/16691, WO 9515328, WO 95/07468, WO
95/04738, WO 95/04060, WO 94/25022, WO 94/21644, WO 94/18207, WO
94/10843, WO 94/09010, WO 94/04540, WO 94/02485, WO 94/02137, WO
94/02136, WO 93/25533, WO 93/18043, WO 93/13663, WO 93/11130, WO
93/10122, WO 93/04680, WO 92/14737, and WO 92/05179. Representative
U.S. patents include U.S. Pat. Nos. 6,342,507; 5,985,890;
5,604,234; 5,597,715; 5,583,139; 5,563,172; 5,561,228; 5,561,137;
5,541,193; 5,541,189; 5,534,632; 5,527,907; 5,484,799; 5,457,194;
5,457,182; 5,362,735; 5,324,644; 5,318,895; 5,310,903; 5,310,901;
5,258,389; 5,252,732; 5,247,076; 5,225,403; 5,221,625; 5,210,030;
5,208,241, 5,200,411; 5,198,421; 5,147,877; 5,140,018; 5,116,756;
5,109,112; 5,093,338; and 5,091,389.
[0316] In one aspect, the fibrosis-inhibiting agent may be, e.g.,
rapamycin (sirolimus), everolimus, biolimus, tresperimus,
auranofin, 27-0-demethylrapamycin, tacrolimus, gusperimus,
pimecrolimus, or ABT-578.
[0317] 19) Inosine Monophosphate Dehydrogenase Inhibitors
[0318] In another embodiment, the pharmacologically active compound
is an inosine monophosphate dehydrogenase (IMPDH) inhibitor (e.g.,
mycophenolic acid, mycophenolate mofetil (4-hexenoic acid,
6-(1,3-dihydro-4-hydroxy-6--
methoxy-7-methyl-3-oxo-5-isobenzofuranyl)-4-methyl-,
2-(4-morpholinyl)ethyl ester, (E)-), ribavirin
(1H-1,2,4-triazole-3-carbo- xamide, 1-.beta.-D-ribofuranosyl-),
tiazofurin (4-thiazolecarboxamide, 2-.beta.-D-ribofuranosyl-),
viramidine, aminothiadiazole, thiophenfurin, tiazofurin) or an
analogue or derivative thereof. Additional representative examples
are included in U.S. Pat. Nos. 5,536,747, 5,807,876, 5,932,600,
6,054,472, 6,128,582, 6,344,465, 6,395,763, 6,399,773, 6,420,403,
6,479,628, 6,498,178, 6,514,979, 6,518,291, 6,541,496, 6,596,747,
6,617,323, 6,624,184, Patent Application Publication Nos.
2002/0040022A1, 2002/0052513A1, 2002/0055483A1, 2002/0068346A1,
2002/0111378A1, 2002/0111495A1, 2002/0123520A1, 2002/0143176A1,
2002/0147160A1, 2002/0161038A1, 2002/0173491A1, 2002/0183315A1,
2002/0193612A1, 2003/0027845A1, 2003/0068302A1, 2003/0105073A1,
2003/0130254A1, 2003/0143197A1, 2003/0144300A1, 2003/0166201A1,
2003/0181497A1, 2003/0186974A1, 2003/0186989A1, 2003/0195202A1, and
PCT Publication Nos. WO 0024725A1, WO 00/25780A1, WO 00/26197A1, WO
00/51615A1, WO 00/56331A1, WO 00/73288A1, WO 01/00622A1, WO
01/66706A1, WO 01/79246A2, WO 01/81340A2, WO 01/85952A2, WO
02/16382A1, WO 02/18369A2, WO 2051814A1, WO 2057287A2, W02057425A2,
WO 2060875A1, WO 2060896A1, WO 2060898A1, WO 2068058A2, WO
3020298A1, WO 3037349A1, WO 3039548A1, WO 3045901A2, WO 3047512A2,
WO 3053958A1, WO 3055447A2, WO 3059269A2, WO 3063573A2, WO 3087071
A1, WO 90/01545A1, WO 97/40028A1, WO 97/41211A1, WO 98/40381A1, and
WO 99/55663A1).
[0319] 20) Leukotriene Inhibitors
[0320] In another embodiment, the pharmacologically active compound
is a leukotreine inhibitor (e.g., ONO-4057(benzenepropanoic acid,
2-(4-carboxybutoxy)-6-((6-(4-methoxyphenyl)-5-hexenyl)oxy)-, (E)-),
ONO-LB-448, pirodomast 1,8-naphthyridin-2(1H)-one,
4-hydroxy-1-phenyl-3-(1-pyrrolidinyl)-, Sch-40120
(benzo(b)(1,8)naphthyri- din-5(7H)-one,
10-(3-chlorophenyl)-6,8,9,10-tetrahydro-), L-656224
(4-benzofuranol,
7-chloro-2-((4-methoxyphenyl)methyl)-3-methyl-5-propyl-)- , MAFP
(methyl arachidonyl fluorophosphonate), ontazolast
(2-benzoxazolamine,
N-(2-cyclohexyl-1-(2-pyridinyl)ethyl)-5-methyl-, (S)-), amelubant
(carbamic acid, ((4-((3-((4-(1-(4-hydroxyphenyl)-1-methy-
lethyl)phenoxy)methyl)phenyl)methoxy)phenyl)iminomethyl)-ethyl
ester), SB-201993 (benzoic acid,
3-((((6-((1E)-2-carboxyethenyl)-5-((8-(4-methoxy-
phenyl)octyl)oxy)-2-pyridinyl)methyl)thio)methyl)-), LY-203647
(ethanone,
1-(2-hydroxy-3-propyl-4-(4-(2-(4-(1H-tetrazol-5-yl)butyl)-2H-tetrazol-5-y-
l)butoxy)phenyl)-), LY-210073, LY-223982 (benzenepropanoic acid,
5-(3-carboxybenzoyl)-2-((6-(4-methoxyphenyl)-5-hexenyl)oxy)-,
(E)-), LY-293111 (benzoic acid,
2-(3-(3-((5-ethyl-4'-fluoro-2-hydroxy(1,1'-biphe-
nyl)-4-yl)oxy)propoxy)-2-propylphenoxy)-), SM-9064
(pyrrolidine,1-(4,11-di-
hydroxy-13-(4-methoxyphenyl)-1-oxo-5,7,9-tridecatrienyl)-,
(E,E,E)-), T-0757 (2,6-octadienamide,
N-(4-hydroxy-3,5-dimethylphenyl)-3,7-dimethyl-- , (2E)-), or an
analogue or derivative thereof).
[0321] 21) MCP-1 Antagonists
[0322] In another embodiment, the pharmacologically active compound
is a MCP-1 antagonist (e.g., nitronaproxen (2-napthaleneacetic
acid, 6-methoxy-alpha-methyl 4-(nitrooxy)butyl ester (alpha S)-),
bindarit (2-(1-benzylindazol-3-ylmethoxy)-2-methylpropanoic-acid),
1-alpha-25 dihydroxy vitamin D.sub.3, or an analogue or derivative
thereof).
[0323] 22) MMP Inhibitors
[0324] In another embodiment, the pharmacologically active compound
is a matrix metalloproteinase (MMP) inhibitor (e.g., D-9120,
doxycycline (2-naphthacenecarboxamide,
4-(dimethylamino)-1,4,4a,5,5a,6,11,12a-octahyd-
ro-3,5,10,12,12a-pentahydroxy-6-methyl-1,11-dioxo-(4S-(4 alpha, 4a
alpha, 5 Ipha, 5a alpha, 6 alpha, 12a alpha))-), BB-2827, BB-1101
(2S-allyl-N1-hydroxy-3R-isobutyl-N4-(1S-methylcarbamoyl-2-phenylethyl)-su-
ccinamide), BB-2983, solimastat
(N'-(2,2-dimethyl-1(S)-(N-(2-pyridyl)carba-
moyl)propyl)-N4-hydroxy-2(R)-isobutyl-3(S)-methoxysuccinamide),
batimastat (butanediamide,
N4-hydroxy-N1-(2-(methylamino)-2-oxo-1-(phenylmethyl)ethy-
l)-2-(2-methylpropyl)-3-((2-thienylthio)methyl)-, (2R-(1
(S*),2R*,3S*))-), CH-138, CH-5902, D-1927, D-5410, EF-13
(gamma-linolenic acid lithium salt),CMT-3
(2-naphthacenecarboxamide, 1,4,4a,5,5a,6,11,12a-octahydro-3,1-
0,12,12a-tetrahydroxy-1,11-dioxo-, (4aS,5aR, 12aS)-), marimastat
(N-(2,2-dimethyl-1(S)-(N-methylcarbamoyl)propyl)-N,3(S)-dihydroxy-2(R)-is-
obutylsuccinamide), TIMP'S,ONO-4817, rebimastat (L-Valinamide,
N-((2S)-2-mercapto-1-oxo-4-(3,4,4-trimethyl-2,5-dioxo-1-imidazolidinyl)bu-
tyl)-L-leucyl-N,3-dimethyl-), PS-508, CH-715, nimesulide
(methanesulfonamide, N-(4-nitro-2-phenoxyphenyl)-),
hexahydro-2-(2(R)-(1(RS)-(hydroxycarbamoyl)-4-phenylbutyl)nonanoyl)-N-(2,-
2,6,6-etramethyl-4-piperidinyl)-3(S)-pyridazine carboxamide,
Rs-113-080, Ro-1130830, cipemastat (1-piperidinebutanamide,
.beta.-(cyclopentylmethyl-
)-N-hydroxy-gamma-oxo-alpha-((3,4,4-trimethyl-2,5-dioxo-1-imidazolidinyl)m-
ethyl)-,(alpha R,.beta.R)-),
5-(4'-biphenyl)-5-(N-(4-nitrophenyl)piperazin- yl)barbituric acid,
6-methoxy-1,2,3,4-tetrahydro-norharman-1-carboxylic acid,
Ro-31-4724 (L-alanine,
N-(2-(2-(hydroxyamino)-2-oxoethyl)-4-methyl--
1-oxopentyl)-L-leucyl-, ethyl ester), prinomastat
(3-thiomorpholinecarboxa- mide,
N-hydroxy-2,2-dimethyl-4-((4-(4-pyridinyloxy) phenyl)sulfonyl)-,
(3R)-), AG-3433 (1H-pyrrole-3-propanic acid,
1-(4'-cyano(1,1'-biphenyl)-4-
-yl)-b-((((3S)-tetrahydro-4,4-dimethyl-2-oxo-3-furanyl)amino)carbonyl)-,ph-
enylmethyl ester, (bS)-), PNU-142769 (2H-Isoindole-2-butanamide,
1,3-dihydro-N-hydroxy-alpha-((3S)-3-(2-methylpropyl)-2-oxo-1-(2-phenyleth-
yl)-3-pyrrolidinyl)-1,3-dioxo-, (alpha R)-),
(S)-1-(2-((((4,5-dihydro-5-th-
ioxo-1,3,4-thiadiazol-2-yl)amino)-carbonyl)amino)-1-oxo-3-(pentafluorophen-
yl)propyl)-4-(2-pyridinyl)piperazine, SU-5402
(1H-pyrrole-3-propanoic acid,
2-((1,2-dihydro-2-oxo-3H-indol-3-ylidene)methyl)-4-methyl-),
SC-77964, PNU-171829, CGS-27023A,
N-hydroxy-2(R)-((4-methoxybenzene-sulfo-
nyl)(4-picolyl)amino)-2-(2-tetrahydrofuranyl)-acetamide, L-758354
((1,1'-biphenyl)-4-hexanoic acid,
alpha-butyl-gamma-(((2,2-dimethyl-1-((m-
ethylamino)carbonyl)propyl)amino)carbonyl)-4'-fluoro-, (alpha
S-(alpha R*, gammaS*(R*)))-, GI-155704A, CPA-926, TMI-005, XL-784,
or an analogue or derivative thereof). Additional representative
examples are included in U.S. Pat. Nos. 5,665,777; 5,985,911;
6,288,261; 5,952,320; 6,441,189; 6,235,786; 6,294,573; 6,294,539;
6,563,002; 6,071,903; 6,358,980; 5,852,213; 6,124,502; 6,160,132;
6,197,791; 6,172,057; 6,288,086; 6,342,508; 6,228,869; 5,977,408;
5,929,097; 6,498,167; 6,534,491; 6,548,524; 5,962,481; 6,197,795;
6,162,814; 6,441,023; 6,444,704; 6,462,073; 6,162,821; 6,444,639;
6,262,080; 6,486,193; 6,329,550; 6,544,980; 6,352,976; 5,968,795;
5,789,434; 5,932,763; 6,500,847; 5,925,637; 6,225,314; 5,804,581;
5,863,915; 5,859,047; 5,861,428; 5,886,043; 6,288,063; 5,939,583;
6,166,082; 5,874,473; 5,886,022; 5,932,577; 5,854,277; 5,886,024;
6,495,565; 6,642,255; 6,495,548; 6,479,502; 5,696,082; 5,700,838;
6,444,639; 6,262,080; 6,486,193; 6,329,550; 6,544,980; 6,352,976;
5,968,795; 5,789,434; 5,932,763; 6,500,847; 5,925,637; 6,225,314;
5,804,581; 5,863,915; 5,859,047; 5,861,428; 5,886,043; 6,288,063;
5,939,583; 6,166,082; 5,874,473; 5,886,022; 5,932,577; 5,854,277;
5,886,024; 6,495,565; 6,642,255; 6,495,548; 6,479,502; 5,696,082;
5,700,838; 5,861,436; 5,691,382; 5,763,621; 5,866,717; 5,902,791;
5,962,529; 6,017,889; 6,022,873; 6,022,898; 6,103,739; 6,127,427;
6,258,851; 6,310,084; 6,358,987; 5,872,152; 5,917,090; 6,124,329;
6,329,373; 6,344,457; 5,698,706; 5,872,146; 5,853,623; 6,624,144;
6,462,042; 5,981,491; 5,955,435; 6,090,840; 6,114,372; 6,566,384;
5,994,293; 6,063,786; 6,469,020; 6,118,001; 6,187,924; 6,310,088;
5,994,312; 6,180,611; 6,110,896; 6,380,253; 5,455,262; 5,470,834;
6,147,114; 6,333,324; 6,489,324; 6,362,183; 6,372,758; 6,448,250;
6,492,367; 6,380,258; 6,583,299; 5,239,078; 5,892,112; 5,773,438;
5,696,147; 6,066,662; 6,600,057; 5,990,158; 5,731,293; 6,277,876;
6,521,606; 6,168,807; 6,506,414; 6,620,813; 5,684,152; 6,451,791;
6,476,027; 6,013,649; 6,503,892; 6,420,427; 6,300,514; 6,403,644;
6,177,466; 6,569,899; 5,594,006; 6,417,229; 5,861,510; 6,156,798;
6,387,931; 6,350,907; 6,090,852; 6,458,822; 6,509,337; 6,147,061;
6,114,568; 6,118,016; 5,804,593; 5,847,153; 5,859,061; 6,194,451;
6,482,827; 6,638,952; 5,677,282; 6,365,630; 6,130,254; 6,455,569;
6,057,369; 6,576,628; 6,110,924; 6,472,396; 6,548,667; 5,618,844;
6,495,578; 6,627,411; 5,514,716; 5,256,657; 5,773,428; 6,037,472;
6,579,890; 5,932,595; 6,013,792; 6,420,415; 5,532,265; 5,691,381;
5,639,746; 5,672,598; 5,830,915; 6,630,516; 5,324,634; 6,277,061;
6,140,099; 6,455,570; 5,595,885; 6,093,398; 6,379,667; 5,641,636;
5,698,404; 6,448,058; 6,008,220; 6,265,432; 6,169,103; 6,133,304;
6,541,521; 6,624,196; 6,307,089; 6,239,288; 5,756,545; 6,020,366;
6,117,869; 6,294,674; 6,037,361; 6,399,612; 6,495,568; 6,624,177;
5,948,780; 6,620,835; 6,284,513; 5,977,141; 6,153,612; 6,297,247;
6,559,142; 6,555,535; 6,350,885; 5,627,206; 5,665,764; 5,958,972;
6,420,408; 6,492,422; 6,340,709; 6,022,948; 6,274,703; 6,294,694;
6,531,499; 6,465,508; 6,437,177; 6,376,665; 5,268,384; 5,183,900;
5,189,178; 6,511,993; 6,617,354; 6,331,563; 5,962,466; 5,861,427;
5,830,869; and 6,087,359.
[0325] 23) NF kappa B Inhibitors
[0326] In another embodiment, the pharmacologically active compound
is a NF kappa B (NFKB) inhibitor (e.g., AVE-0545, Oxi-104
(benzamide, 4-amino-3-chloro-N-(2-(diethylamino)ethyl)-),
dexlipotam, R-flurbiprofen ((1,1'-biphenyl)-4-acetic acid,
2-fluoro-alpha-methyl), SP100030
(2-chloro-N-(3,5-di(trifluoromethyl)phenyl)-4-(trifluoromethyl)pyrimidine-
-5-carboxamide), AVE-0545, Viatris, AVE-0547, Bay 11-7082, Bay
11-7085,15 deoxy-prostaylandin J2, bortezomib (boronic acid,
((1R)-3-methyl-1-(((2S)-
-1-oxo-3-phenyl-2-((pyrazinylcarbonyl)amino)propyl)amino)butyl)-,
benzamide an d nicotinamide derivatives that inhibit NF-kappaB,
such as those described in U.S. Pat. Nos. 5,561,161 and 5,340,565
(OxiGene), PG490-88Na, or an analogue or derivative thereof).
[0327] 24) NO Antagonists
[0328] In another embodiment, the pharmacologically active compound
is a NO antagonist (e.g., NCX-4016 (benzoic acid, 2-(acetyloxy)-,
3-((nitrooxy)methyl)phenyl ester, NCX-2216, L-arginine or an
analogue or derivative thereof).
[0329] 25) P38 MAP Kinase Inhibitors
[0330] In another embodiment, the pharmacologically active compound
is a p38 MAP kinase inhibitor (e.g., GW-2286, CGP-52411, BIRB-798,
SB220025, RO-320-1195, RWJ-67657, RWJ-68354, SCI0-469, SCIO-323,
AMG-548, CMC-146, SD-31145, CC-8866, Ro-320-1195, PD-98059
(4H-1-benzopyran-4-one, 2-(2-amino-3-methoxyphenyl)-), CGH-2466,
doramapimod, SB-203580 (pyridine,
4-(5-(4-fluorophenyl)-2-(4-(methylsulfinyl)phenyl)-1H-imidazol-
-4-yl)-), SB-220025
((5-(2-amino-4-pyrimidinyl)-4-(4-fluorophenyl)-1-(4-pi-
peridinyl)imidazole), SB-281832, PD169316, SB202190, GSK-681323,
EO-1606, GSK-681323, or an analogue or derivative thereof).
Additional representative examples are included in U.S. Pat. Nos.
6,300,347; 6,316,464; 6,316,466; 6,376,527; 6,444,696; 6,479,507;
6,509,361; 6,579,874; 6,630,485, U.S. Patent Application
Publication Nos. 2001/0044538A1; 2002/0013354A1; 2002/0049220A1;
2002/0103245A1; 2002/0151491A1; 2002/0156114A1; 2003/0018051A1;
2003/0073832A1; 2003/0130257A1; 2003/0130273A1; 2003/0130319A1;
2003/0139388A1; 20030139462A1; 2003/0149031A1; 2003/0166647A1;
2003/0181411A1; and PCT Publication Nos. WO 00/63204A2; WO
01/21591A1; WO 01/35959A1; WO 01/74811A2; WO 02/18379A2; WO
2064594A2; WO 2083622A2; WO 2094842A2; WO 2096426A1; WO 2101015A2;
WO 2103000A2; WO 3008413A1; WO 3016248A2; WO 3020715A1; WO
3024899A2; WO 3031431 A1; WO3040103A1; WO 3053940A1; WO 3053941A2;
WO 3063799A2; WO 3079986A2; WO 3080024A2; WO 3082287A1; WO
97/44467A1; WO 99/01449A1; and WO 99/58523A1.
[0331] 26) Phosphodiesterase Inhibitors
[0332] In another embodiment, the pharmacologically active compound
is a phosphodiesterase inhibitor (e.g., CDP-840 (pyridine,
4-((2R)-2-(3-(cyclopentyloxy)-4-methoxyphenyl)-2-phenylethyl)-),
CH-3697, CT-2820, D-22888
(imidazo(1,5-a)pyrido(3,2-e)pyrazin-6(5H)-one,
9-ethyl-2-methoxy-7-methyl-5-propyl-), D-4418
(8-methoxyquinoline-5-(N-(2- ,5-dichloropyridin-3-yl))carboxamide),
1-(3-cyclopentyloxy-4-methoxyphenyl- )-2-(2,6-dichloro-4-pyridyl)
ethanone oxime, D-4396, ONO-6126, CDC-998, CDC-801, V-11294A
(3-(3-(cyclopentyloxy)-4-methoxybenzyl)-6-(ethylamino)--
8-isopropyl-3H-purine hydrochloride),
S,S'-methylene-bis(2-(8-cyclopropyl--
3-propyl-6-(4-pyridylmethylamino)-2-thio-3H-purine))tetrahyrochloride,
rolipram (2-pyrrolidinone,
4-(3-(cyclopentyloxy)-4-methoxyphenyl)-), CP-293121, CP-353164
(5-(3-cyclopentyloxy-4-methoxyphenyl)pyridine-2-carb- oxamide),
oxagrelate (6-phthalazinecarboxylic acid,
3,4-dihydro-1-(hydroxymethyl)-5,7-dimethyl-4-oxo-, ethyl ester),
PD-168787, ibudilast (1-propanone,
2-methyl-1-(2-(1-methylethyl)pyrazolo(- 1,5-a)pyridin-3-yl)-),
oxagrelate (6-phthalazinecarboxylic acid,
3,4-dihydro-1-(hydroxymethyl)-5,7-dimethyl-4-oxo-, ethyl ester),
griseolic acid (alpha-L-talo-oct-4-enofuranuronic acid,
1-(6-amino-9H-purin-9-yl)-3,6-anhydro-6-C-carboxy-1,5-dideoxy-),
KW-4490, KS-506, T-440, roflumilast (benzamide,
3-(cyclopropylmethoxy)-N-(3,5-dich-
loro-4-pyridinyl)-4-(difluoromethoxy)-), rolipram, milrinone,
triflusinal (benzoic acid, 2-(acetyloxy)-4-(trifluoromethyl)-),
anagrelide hydrochloride (imidazo(2,1-b)quinazolin-2(3H)-one,
6,7-dichloro-1,5-dihydro-, monohydrochloride), cilostazol
(2(1H)-quinolinone,
6-(4-(1-cyclohexyl-1H-tetrazol-5-yl)butoxy)-3,4-dihyd- ro-),
propentofylline (1H-purine-2,6-dione,
3,7-dihydro-3-methyl-1-(5-oxoh- exyl)-7-propyl-), sildenafil
citrate (piperazine, 1-((3-(4,7-dihydro-1-met-
hyl-7-oxo-3-propyl-1H-pyrazolo(4,3-d)pyrimidin-5-yl)-4-ethoxyphenyl)sulfon-
yl)-4-methyl, 2-hydroxy-1,2,3-propanetricarboxylate-(1:1)),
tadalafil (pyrazino(1',2':1,6)pyrido(3,4-b)indole 1,4-dione,
6-(1,3-benzodioxol-5-yl)-2,3,6,7,12,12a-hexahydro-2-methyl-,
(6R-trans)), vardenafil (piperazine,
1-(3-(1,4-dihydro-5-methyl(-4-oxo-7-propylimidazo-
(5,1-f)(1,2,4)-triazin-2-yl)-4-ethoxyphenyl)sulfonyl)-4-ethyl-),
milrinone ((3,4'-bipyridine)-5-carbonitrile,
1,6-dihydro-2-methyl-6-oxo-), enoximone (2H-imidazol-2-one,
1,3-dihydro-4-methyl-5-(4-(methylthio)benzo- yl)-), theophylline
(1H-purine-2,6-dione, 3,7-dihydro-1,3-dimethyl-), ibudilast
(1-propanone, 2-methyl-1-(2-(1-methylethyl)pyrazolo(1,5-a)pyrid-
in-3-yl)-), aminophylline (1H-purine-2,6-dione,
3,7-dihydro-1,3-dimethyl-, compound with 1,2-ethanediamine
(2:1)-),acebrophylline (7H-purine-7-acetic acid,
1,2,3,6-tetrahydro-1,3-dimethyl-2,6-dioxo-,comp- d. with
trans-4-(((2-amino-3,5-dibromophenyl)methyl)amino)cyclohexanol
(1:1)), plafibride (propanamide,
2-(4-chlorophenoxy)-2-methyl-N-(((4-morp-
holinylmethyl)amino)carbonyl)-), ioprinone hydrochloride
(3-pyridinecarbonitrile,
1,2-dihydro-5-imidazo(1,2-a)pyridin-6-yl-6-methy- l-2-oxo-,
monohydrochloride-), fosfosal (benzoic acid, 2-(phosphonooxy)-),
amrinone ((3,4'-bipyridin)-6(1H)-one, 5-amino-, or an analogue or
derivative thereof).
[0333] Other examples of phosphodiesterase inhibitors include
denbufylline (1H-purine-2,6-dione,
1,3-dibutyl-3,7-dihydro-7-(2-oxopropyl)-), propentofylline
(1H-purine-2,6-dione, 3,7-dihydro-3-methyl-1-(5-oxohexyl)-
-7-propyl-) and pelrinone (5-pyrimidinecarbonitrile,
1,4-dihydro-2-methyl-4-oxo-6-[(3-pyridinylmethyl)amino]-).
[0334] Other examples of phosphodiesterase III inhibitors include
enoximone (2H-imidazol-2-one,
1,3-dihydro-4-methyl-5-[4-(methylthio)benzo- yl]-), and saterinone
(3-pyridinecarbonitrile, 1,2-dihydro-5-[4-[2-hydroxy-
-3-[4-(2-methoxyphenyl)-1-piperazinyl]propoxy]phenyl]-6-methyl-2-oxo-).
[0335] Other examples of phosphodiesterase IV inhibitors include
AWD-12-281, 3-auinolinecarboxylic acid,
1-ethyl-6-fluoro-1,4-dihydro-7-(4- -methyl-1-piperazinyl)-4-oxo-),
tadalafil (pyrazino(1',2':1,6)pyrido(3,4-b- )indolel,4-dione,
6-(1,3-benzodioxol-5-yl)-2,3,6,7,12,12a-hexahydro-2-meth- yl-,
(6R-trans)), and filaminast (ethanone,
1-[3-(cyclopentyloxy)-4-methox- yphenyl]-, O-(aminocarbonyl)oxime,
(1E)-)
[0336] Another example of a phosphodiesterase V inhibitor is
vardenafil (piperazine,
1-(3-(1,4-dihydro-5-methyl(-4-oxo-7-propylimidazo(5,1-f)(1,2-
,4)-triazin-2-yl)-4-ethoxyphenyl)sulfonyl)-4-ethyl-).
[0337] 27) TGF Beta Inhibitors
[0338] In another embodiment, the pharmacologically active compound
is a TGF beta Inhibitor (e.g., mannose-6-phosphate, LF-984,
tamoxifen (ethanamine,
2-(4-(1,2-diphenyl-1-butenyl)phenoxy)-N,N-dimethyl-, (Z)-),
tranilast, or an analogue or derivative thereof).
[0339] 28) Thromboxane A2 Antagonists
[0340] In another embodiment, the pharmacologically active compound
is a thromboxane A2 antagonist (e.g., CGS-22652
(3-pyridineheptanoic acid,
.gamma.-(4-(((4-chlorophenyl)sulfonyl)amino)butyl)-, (..+-..)-),
ozagrel (2-propenoic acid, 3-(4-(1H-imidazol-1-ylmethyl)phenyl)-,
(E)-), argatroban (2-piperidinecarboxylic acid,
1-(5-((aminoiminomethyl)amino)-1-
-oxo-2-(((1,2,3,4-tetrahydro-3-methyl-8-quinolinyl)sulfonyl)amino)pentyl)--
4-methyl-), ramatroban (9H-carbazole-9-propanoic acid,
3-(((4-fluorophenyl)sulfonyl)amino)-1,2,3,4-tetrahydro-, (R)-),
torasemide (3-pyridinesulfonamide,
N-(((1-methylethyl)amino)carbonyl)-4-(- (3-methylphenyl)amino)-),
gamma linoleic acid ((Z,Z,Z)-6,9,12-octadecatrie- noic acid),
seratrodast (benzeneheptanoic acid, zeta-(2,4,5-trimethyl-3,6--
dioxo-1,4-cyclohexadien-1-yl)-, (.+-.)-, or an analogue or
derivative thereof). 29) TNF alpha Antagonists and TACE
Inhibitors
[0341] In another embodiment, the pharmacologically active compound
is a TNF alpha antagonist or TACE inhibitor (e.g., E-5531
(2-deoxy-6-0-(2-deoxy-3-0-(3(R)-(5(Z)-dodecenoyloxy)-decyl)-6-0-methyl-2--
(3-oxotetradecanamido)-4-O-phosphono-.beta.-D-glucopyranosyl)-3-0-(3(R)-hy-
droxydecyl)-2-(3-oxotetradecanamido)-alpha-D-glucopyranose-1-O-phosphate),
AZD-4717, glycophosphopeptical, UR-12715 (B=benzoic acid,
2-hydroxy-5-((4-(3-(4-(2-methyl-1H-imidazol(4,5-c)pyridin-1-yl)methyl)-1--
piperidinyl)-3-oxo-1-phenyl-1-propenyl)phenyl)azo) (Z)), PMS-601,
AM-87, xyloadenosine (9H-purin-6-amine, 9-1-D-xylofuranosyl-),
RDP-58, RDP-59, BB2275, benzydamine, E-3330 (undecanoic acid,
2-((4,5-dimethoxy-2-methyl--
3,6-dioxo-1,4-cyclohexadien-1-yl)methylene)-, (E)-),
N-(D,L-2-(hydroxyaminocarbonyl)methyl-4-methylpentanoyl)-L-3-(2'-naphthyl-
)alanyl-L-alanine, 2-aminoethyl amide, CP-564959, MLN-608, SPC-839,
ENMD-0997, Sch-23863 ((2-(10,11-dihydro-5-ethoxy-5H-dibenzo (a,d)
cyclohepten-S-yl)-N,N-dimethyl-ethanamine), SH-636, PKF-241-466,
PKF-242-484, TNF-484A, cilomilast
(cis-4-cyano-4-(3-(cyclopentyloxy)-4-me-
thoxyphenyl)cyclohexane-1-carboxylic acid), GW-3333, GW-4459,
BMS-561392, AM-87, cloricromene (acetic acid,
((8-chloro-3-(2-(diethylamino)ethyl)-4--
methyl-2-oxo-2H-1-benzopyran-7-yl)oxy)-, ethyl ester), thalidomide
(1H-Isoindole-1,3(2H)-dione, 2-(2,6-dioxo-3-piperidinyl)-),
vesnarinone (piperazine,
1-(3,4-dimethoxybenzoyl)-4-(1,2,3,4-tetrahydro-2-oxo-6-quino-
linyl)-), infliximab, lentinan, etanercept (1-235-tumor necrosis
factor receptor (human) fusion protein with 236-467-immunoglobulin
G1 (human gamma1-chain Fc fragment)), diacerein
(2-anthracenecarboxylic acid,
4,5-bis(acetyloxy)-9,10-dihydro-9,10-dioxo-, or an analogue or
derivative thereof).
[0342] 30) Tyrosine Kinase Inhibitors
[0343] In another embodiment, the pharmacologically active compound
is a tyrosine kinase inhibitor (e.g., SKI-606, ER-068224, SD-208,
N-(6-benzothiazolyl)-4-(2-(1-piperazinyl)pyrid-5-yl)-2-pyrimidineamine,
celastrol (24,25,26-trinoroleana-1(10),3,5,7-tetraen-29-oic acid,
3-hydroxy-9,13-dimethyl-2-oxo-, (9 beta.,13alpha,14.beta.,20
alpha)-), CP-127374 (geldanamycin,
17-demethoxy-17-(2-propenylamino)-), CP-564959, PD-171026,
CGP-52411(1H-Isoindole-1,3(2H)-dione, 4,5-bis(phenylamino)-),
CGP-53716 (benzamide,
N-(4-methyl-3-((4-(3-pyridinyl)-2-pyrimidinyl)amino- )phenyl)-),
imatinib (4-((methyl-1-piperazinyl)methyl)-N-(4-methyl-3-((4-(-
3-pyridinyl)-2-pyrimidinyl)aminoyphenyl)benzamide
methanesulfonate), NVP-AAK980-NX, KF-250706
(13-chloro,5(R),6(S)-epoxy-14,16-dihydroxy-11-(h-
ydroyimino)-3(R)-methyl-3,4,5,6,11,12-hexahydro-1H-2-benzoxacyclotetradeci-
n-1-one),
5-(3-(3-methoxy-4-(2-((E)-2-phenylethenyl)-4-oxazolylmethoxy)phe-
nyl)propyl)-3-(2-((E)-2-phenylethenyl)-4-oxazolylmethyl)-2,4-oxazolidinedi-
one, genistein, NV-06, or an analogue or derivative thereof).
[0344] 31) Vitronectin Inhibitors
[0345] In another embodiment, the pharmacologically active compound
is a vitronectin inhibitor (e.g.,
O-(9,10-dimethoxy-1,2,3,4,5,6-hexahydro-4-((-
1,4,5,6-tetrahydro-2-pyrimidinyl)hydrazono)-8-benz(e)azulenyl)-N-((phenylm-
ethoxy)carbonyl)-DL-homoserine 2,3-dihydroxypropyl ester,
(2S)-benzoylcarbonylamino-3-(2-((4S)-(3-(4,5-dihydro-1H-imidazol-2-ylamin-
o)-propyl)-2,5-dioxo-imidazolidin-1-yl)-acetylamino)-propionate,
Sch-221153, S-836, SC-68448
(.beta.-((2-2-(((3-((aminoiminomethyl)amino)--
phenyl)carbonyl)amino)acetyl)amino)-3,5-dichlorobenzenepropanoic
acid), SD-7784, S-247, or an analogue or derivative thereof).
[0346] 32) Fibroblast Growth Factor Inhibitors
[0347] In another embodiment, the pharmacologically active compound
is a fibroblast growth factor inhibitor (e.g., CT-052923
(((2H-benzo(d)1,3-dioxalan-5-methyl)amino)(4-(6,7-dimethoxyquinazolin-4-y-
l)piperazinyl)methane-1-thione), or an analogue or derivative
thereof).
[0348] 33) Protein Kinase Inhibitors
[0349] In another embodiment, the pharmacologically active compound
is a protein kinase inhibitor (e.g., KP-0201448, NPC15437
(hexanamide,
2,6-diamino-N-((1-(1-oxotridecyl)-2-piperidinyl)methyl)-), fasudil
(1H-1,4-diazepine, hexahydro-1-(5-isoquinolinylsulfonyl)-),
midostaurin (benzamide,
N-(2,3,10,11,12,13-hexahydro-10-methoxy-9-methyl-1-oxo-9,13-e-
poxy-1H
,9H-diindolo(1,2,3-gh:3',2',1'-Im)pyrrolo(3,4-j)(1,7)benzodiazonin-
-11-yl)-N-methyl-, (9Alpha,10.beta.11.beta.,13Alpha)-),fasudil
(1H-1,4-diazepine, hexahydro-1-(5-isoquinolinylsulfonyl)-,
dexniguldipine (3,5-pyridinedicarboxylic acid,
1,4-dihydro-2,6-dimethyl-4-(3-nitrophenyl- )-,
3-(4,4-diphenyl-1-piperidinyl)propyl methyl ester,
monohydrochloride, (R)-), LY-317615 (1H-pyrole-2,5-dione,
3-(1-methyl-1H-indol-3-yl)-4-[1-[1-
-(2-pyridinylmethyl)-4-piperidinyl]-1H-indol-3-yl]-,
monohydrochloride), perifosine (piperidinium,
4-[[hydroxy(octadecyloxy)phosphinyl]oxy]-1,1-di- methyl-, inner
salt), LY-333531 (9H,18H-5,21:12,17-dimethenodibenzo(e,k)py-
rrolo(3,4-h)(1,4,13)oxadiazacyclohexadecine-18,20(19H)-dione,9-((dimethyla-
mino)methyl)-6,7,10,11-tetrahydro-, (S)-), Kynac; SPC-100270
(1,3-octadecanediol, 2-amino-, [S-(R*,R*)]-), Kynacyte, or an
analogue or derivative thereof).
[0350] 34) PDGF Receptor Kinase Inhibitors
[0351] In another embodiment, the pharmacologically active compound
is a PDGF receptor kinase inhibitor (e.g., RPR-127963E, or an
analogue or derivative thereof).
[0352] 35) Endothelial Growth Factor Receptor Kinase Inhibitors
[0353] In another embodiment, the pharmacologically active compound
is an endothelial growth factor receptor kinase inhibitor (e.g.,
CEP-7055, SU-0879
((E)-3-(3,5-di-tert-butyl-4-hydroxyphenyl)-2-(aminothiocarbonyl)a-
crylonitrile), BIBF-1000, AG-013736 (CP-868596), AMG-706, AVE-0005,
NM-3 (3-(2-methylcarboxymethyl)-6-methoxy-8-hydroxy-isocoumarin),
Bay-43-9006, SU-011248,or an analogue or derivative thereof).
[0354] 36) Retinoic Acid Receptor Antagonists
[0355] In another embodiment, the pharmacologically active compound
is a retinoic acid receptor antagonist (e.g., etarotene
(Ro-15-1570) (naphthalene,
6-(2-(4-(ethylsulfonyl)phenyl)-1-methylethenyl)-1,2,3,4-tet-
rahydro-1,1,4,4-tetramethyl-, (E)-),
(2E,4E)-3-methyl-5-(2-((E)-2-(2,6,6-t-
rimethyl-1-cyclohexen-1-yl)ethenyl)-1-cyclohexen-1-yl)-2,4-pentadienoic
acid, tocoretinate (retinoic acid,
3,4-dihydro-2,5,7,8-tetramethyl-2-(4,8-
,12-trimethyltridecyl)-2H-1-benzopyran-6-yl ester,
(2R*(4R*,8R*))-(.+-.)-)- , aliretinoin (retinoic acid, cis-9,
trans-13-), bexarotene (benzoic acid,
4-(1-(5,6,7,8-tetrahydro-3,5,5,8,8-pentamethyl-2-naphthalenyl)ethenyl)-),
tocoretinate (retinoic acid,
3,4-dihydro-2,5,7,8-tetramethyl-2-(4,8,12-tr-
imethyltridecyl)-2H-1-benzopyran-6-yl ester,
[2R*(4R*,8R*)]-(.+-.)-, or an analogue or derivative thereof).
[0356] 37) Platelet Derived Growth Factor Receptor Kinase
Inhibitors
[0357] In another embodiment, the pharmacologically active compound
is a platelet derived growth factor receptor kinase inhibitor
(e.g., leflunomide (4-isoxazolecarboxamide,
5-methyl-N-(4-(trifluoromethyl)pheny- l)-, or an analogue or
derivative thereof).
[0358] 38) Fibrinogen Antagonists
[0359] In another embodiment, the pharmacologically active compound
is a fibrinogin antagonist (e.g., picotamide
(1,3-benzenedicarboxamide, 4-methoxy-N,N'-bis(3-pyridinylmethyl)-,
or an analogue or derivative thereof).
[0360] 39) Antimycotic Agents
[0361] In another embodiment, the pharmacologically active compound
is an antimycotic agent (e.g., miconazole, sulconizole,
parthenolide, rosconitine, nystatin, isoconazole, fluconazole,
ketoconasole, imidazole, itraconazole, terpinafine, elonazole,
bifonazole, clotrimazole, conazole, terconazole (piperazine,
1-(4-((2-(2,4-dichlorophenyl)-2-(1H-1,2,4-triazo-
l-1-ylmethyl)-1,3-dioxolan-4-yl)methoxy)phenyl)-4-(1-methylethyl)-,
cis-), isoconazole
(1-(2-(2-6-dichlorobenzyloxy)-2-(2-,4-dichlorophenyl)ethyl)),
griseofulvin (spiro(benzofuran-2(3H),1'-(2)cyclohexane)-3,4'-dione,
7-chloro-2',4,6-trimeth-oxy-6'methyl-, (1'S-trans)-), bifonazole
(1H-imidazole, 1-((1,1'-biphenyl)-4-ylphenylmethyl)-), econazole
nitrate
(1-(2-((4-chlorophenyl)methoxy)-2-(2,4-dichlorophenyl)ethyl)-1H-imidazole
nitrate), croconazole (1H-imidazole,
1-(1-(2-((3-chlorophenyl)methoxy)phe- nyl)ethenyl)-), sertaconazole
(1H-Imidazole, 1-(2-((7-chlorobenzo(b)thien--
3-yl)methoxy)-2-(2,4-dichlorophenyl)ethyl)-), omoconazole
(1H-imidazole,
1-(2-(2-(4-chlorophenoxy)ethoxy)-2-(2,4-dichlorophenyl)-1-methylethenyl)--
, (Z)-), flutrimazole (1H-imidazole,
1-((2-fluorophenyl)(4-fluorophenyl)ph- enylmethyl)-), fluconazole
(1H-1,2,4-triazole-1-ethanol,
alpha-(2,4-difluorophenyl)-alpha-(1H-1,2,4-triazol-1-ylmethyl)-),
neticonazole (1H-Imidazole,
1-(2-(methylthio)-1-(2-(pentyloxy)phenyl)ethe- nyl)-,
monohydrochloride, (E)-), butoconazole (1H-imidazole,
1-(4-(4-chlorophenyl)-2-((2,6-dichlorophenyl)thio)butyl)-,
(.+-.-)-), clotrimazole
(1-((2-chlorophenyl)diphenylmethyl)-1H-imidazole, or an analogue or
derivative thereof).
[0362] 40) Bisphosphonates
[0363] In another embodiment, the pharmacologically active compound
is a bisphosphonate (e.g., clodronate, alendronate, pamidronate,
zoledronate, or an analogue or derivative thereof).
[0364] 41) Phospholipase A1 Inhibitors
[0365] In another embodiment, the pharmacologically active compound
is a phospholipase Al inhibitor (e.g., ioteprednol etabonate
(androsta-1,4-diene-17-carboxylic acid,
17-((ethoxycarbonyl)oxy)-11-hydro- xy-3-oxo-, chloromethyl ester,
(11.beta.,17 alpha)-, or an analogue or derivative thereof).
[0366] 42) Histamine H1/H2/H3 Receptor Antagonists
[0367] In another embodiment, the pharmacologically active compound
is a histamine H1, H2, or H3 receptor antagonist (e.g., ranitidine
(1,1-ethenediamine,
N-(2-(((5-((dimethylamino)methyl)-2-furanyl)methyl)th-
io)ethyl)-N'-methyl-2-nitro-), niperotidine
(N-(2-((5-((dimethylamino)meth-
yl)furfuryl)thio)ethyl)-2-nitro-N'-piperonyl-1,1-ethenediamine),
famotidine (propanimidamide,
3-(((2-((aminoiminomethyl)amino)-4-thiazolyl-
)methyl)thio)-N-(aminosulfonyl)-), roxitadine acetate HCl
(acetamide,
2-(acetyloxy)-N-(3-(3-(1-piperidinylmethyl)phenoxy)propyl)-,
monohydrochloride), lafutidine (acetamide,
2-((2-furanylmethyl)sulfinyl)--
N-(4-((4-(1-piperidinylmethyl)-2-pyridinyl)oxy)-2-butenyl)-, (Z)-),
nizatadine (1,1-ethenediamine,
N-(2-(((2-((dimethylamino)methyl)-4-thiazo-
lyl)methyl)thio)ethyl)-N'-methyl-2-nitro-), ebrotidine
(benzenesulfonamide,
N-(((2-(((2-((aminoiminomethyl)amino)-4-thiazoly)met-
hyl)thio)ethyl)amino)methylene)-4-bromo-), rupatadine
(5H-benzo(5,6)cyclohepta(1,2-b)pyridine,
8-chloro-6,11-dihydro-11-(1-((5--
methyl-3-pyridinyl)methyl)-4-piperidinylidene)-,
trihydrochloride-), fexofenadine HCl (benzeneacetic acid,
4-(1-hydroxy-4-(4(hydroxydiphenylme-
thyl)-1-piperidinyl)butyl)-alpha, alpha-dimethyl-, hydrochloride,
or an analogue or derivative thereof).
[0368] 43) Macrolide Antibiotics
[0369] In another embodiment, the pharmacologically active compound
is a macrolide antibiotic (e.g., dirithromycin (erythromycin,
9-deoxo-11-deoxy-9,11-(imino(2-(2-methoxyethoxy)ethylidene)oxy)-,
(9S(R))-), flurithromycin ethylsuccinate (erythromycin,
8-fluoro-mono(ethyl butanedioate) (ester)-), erythromycin
stinoprate (erythromycin, 2'-propanoate, compound with
N-acetyl-L-cysteine (1:1)), clarithromycin (erythromycin,
6-O-methyl-), azithromycin
(9-deoxo-9a-aza-9a-methyl-9a-homoerythromycin-A), telithromycin
(3-de((2,6-dideoxy-3-C-methyl-3-O-methyl-alpha-L-ribo-hexopyranosyl)oxy)--
11,12-dideoxy-6-O-methyl-3-oxo-12,11-(oxycarbonyl((4-(4-(3-pyridinyl)-1H-i-
midazol-1-yl)butyl)imino))-), roxithromycin (erythromycin,
9-(O-((2-methoxyethoxy)methyl)oxime)), rokitamycin (leucomycin V,
4B-butanoate 3B-propanoate), RV-11 (erythromycin monopropionate
mercaptosuccinate), midecamycin acetate (leucomycin V,
3B,9-diacetate 3,4B-dipropanoate), midecamycin (leucomycin V,
3,4B-dipropanoate), josamycin (leucomycin V, 3-acetate
4B-(3-methylbutanoate), or an analogue or derivative thereof).
[0370] 44) GPIIb IIIa Receptor Antagonists
[0371] In another embodiment, the pharmacologically active compound
is a GPIIb IIIa receptor antagonist (e.g., tirofiban hydrochloride
(L-tyrosine, N-(butylsulfonyl)-O-(4-(4-piperidinyl)butyl)-,
monohydrochloride-), eptifibatide (L-cysteinamide,
N6-(aminoiminomethyl)-N2-(3-mercapto-1-oxopropyl)-L-lysylglycyl-L-alpha-a-
spartyl-L-tryptophyl-L-prolyl-, cyclic(1.fwdarw.6)-disulfide),
xemilofiban hydrochloride, or an analogue or derivative
thereof).
[0372] 45) Endothelin Receptor Antagonists
[0373] In another embodiment, the pharmacologically active compound
is an endothelin receptor antagonist (e.g., bosentan
(benzenesulfonamide,
4-(1,1-dimethylethyl)-N-(6-(2-hydroxyethoxy)-5-(2-methoxyphenoxy)(2,2'-bi-
pyrimidin)-4-yl)-, or an analogue or derivative thereof).
[0374] 46) Peroxisome Proliferator-Activated Receptor Agonists
[0375] In another embodiment, the pharmacologically active compound
is a peroxisome proliferator-activated receptor agonist (e.g.,
gemfibrozil (pentanoic acid,
5-(2,5-dimethylphenoxy)-2,2-dimethyl-), fenofibrate (propanoic
acid, 2-(4-(4-chlorobenzoyl)phenoxy)-2-methyl-, 1-methylethyl
ester), ciprofibrate (propanoic acid,
2-(4-(2,2-dichlorocyclopropyl)pheno- xy)-2-methyl-), rosiglitazone
maleate (2,4-thiazolidinedione,
5-((4-(2-(methyl-2-pyridinylamino)ethoxy)phenyl)methyl)-,
(Z)-2-butenedioate (1:1)), pioglitazone hydrochloride
(2,4-thiazolidinedione, 5-((4-(2-(5-ethyl-2-pyridinyl
)ethoxy)phenyl)methyl)-, monohydrochloride (.+-.)-), etofylline
clofibrate (propanoic acid, 2-(4-chlorophenoxy)-2-methyl-,
2-(1,2,3,6-tetrahydro-1,3-dimethyl-2,6-dioxo-7H-purin-7-yl)ethyl
ester), etofibrate (3-pyridinecarboxylic acid,
2-(2-(4-chlorophenoxy)-2-methyl-1-- oxopropoxy)ethyl ester),
clinofibrate (butanoic acid,
2,2'-(cyclohexylidenebis(4,1-phenyleneoxy))bis(2-methyl-)),
bezafibrate (propanoic acid,
2-(4-(2-((4-chlorobenzoyl)amino)ethyl)phenoxy)-2-methyl-- ),
binifibrate (3-pyridinecarboxylic acid,
2-(2-(4-chlorophenoxy)-2-methyl- -1-oxopropoxy)-1,3-propanediyl
ester), or an analogue or derivative thereof).
[0376] In one aspect, the pharmacologically active compound is a
peroxisome proliferator-activated receptor alpha agonist, such as
GW-590735, GSK-677954, GSK501516, pioglitazone hydrochloride
(2,4-thiazolidinedione,
5-[[4-[2-(5-ethyl-2-pyridinyl)ethoxy]phenyl]methy- l]-,
monohydrochloride (.+-.)-, or an analogue or derivative
thereof).
[0377] 47) Estrogen Receptor Agents
[0378] In another embodiment, the pharmacologically active compound
is an estrogen receptor agent (e.g., estradiol,
17-.beta.-estradiol, or an analogue or derivative thereof).
[0379] 48) Somatostatin Analogues
[0380] In another embodiment, the pharmacologically active compound
is a somatostatin analogue (e.g., angiopeptin, or an analogue or
derivative thereof).
[0381] 49) Neurokinin 1 Antagonists
[0382] In another embodiment, the pharmacologically active compound
is a neurokinin 1 antagonist (e.g., GW-597599, lanepitant
((1,4'-bipiperidine)-1'-acetamide,
N-(2-(acetyl((2-methoxyphenyl)methyl)a-
mino)-1-(1H-indol-3-ylmethyl)ethyl)-(R)-), nolpitantium chloride
(1-azoniabicyclo[2.2.2]octane,
1-[2-[3-(3,4-dichlorophenyl)-1-[[3-(1-meth-
ylethoxy)phenyl]acetyl]-3-piperidinyl]ethyl]-4-phenyl-, chloride,
(S)-), or saredutant (benzamide,
N-[4-[4-(acetylamino)-4-phenyl-1-piperidinyl]-2-
-(3,4-dichlorophenyl)butyl]-N-methyl-, (S)-), or vofopitant
(3-piperidinamine,
N-[[2-methoxy-5-[5-(trifluoromethyl)-1H-tetrazol-1-yl]-
phenyl]methyl]-2-phenyl-, (2S,3S)-, or an analogue or derivative
thereof).
[0383] 50) Neurokinin 3 Antagonist
[0384] In another embodiment, the pharmacologically active compound
is a neurokinin 3 antagonist (e.g., talnetant
(4-quinolinecarboxamide,
3-hydroxy-2-phenyl-N-[(1S)-1-phenylpropyl]-, or an analogue or
derivative thereof).
[0385] 51) Neurokinin Antagonist
[0386] In another embodiment, the pharmacologically active compound
is a neurokinin antagonist (e.g., GSK-679769, GSK-823296, SR-489686
(benzamide,
N-[4-[4-(acetylamino)-4-phenyl-1-piperidinyl]-2-(3,4-dichloro-
phenyl)butyl]-N-methyl-, (S)-), SB-223412; SB-235375
(4-quinolinecarboxamide,
3-hydroxy-2-phenyl-N-[(1S)-1-phenylpropyl]-), UK-226471, or an
analogue or derivative thereof).
[0387] 52) VLA-4 Antagonist
[0388] In another embodiment, the pharmacologically active compound
is a VLA-4 antagonist (e.g., GSK683699, or an analogue or
derivative thereof).
[0389] 53) Osteoclast Inhibitor
[0390] In another embodiment, the pharmacologically active compound
is a osteoclast inhibitor (e.g., ibandronic acid (phosphonic acid,
[1-hydroxy-3-(methylpentylamino)propylidene]bis-), alendronate
sodium, or an analogue or derivative thereof).
[0391] 54) DNA Topoisomerase ATP Hydrolysing Inhibitor
[0392] In another embodiment, the pharmacologically active compound
is a DNA topoisomerase ATP hydrolysing inhibitor (e.g., enoxacin
(1,8-naphthyridine-3-carboxylic acid,
1-ethyl-6-fluoro-1,4-dihydro-4-oxo-- 7-(1-piperazinyl)-),
levofloxacin (7H-Pyrido[1,2,3-de]-1,4-benzoxazine-6-c- arboxylic
acid, 9-fluoro-2,3-dihydro-3-methyl-10-(4-methyl-1-piperazinyl)--
7-oxo-, (S)-), ofloxacin
(7H-pyrido[1,2,3-de]-1,4-benzoxazine-6-carboxylic acid,
9-fluoro-2,3-dihydro-3-methyl-10-(4-methyl-1-piperazinyl)-7-oxo-,
(.+-.)-), pefloxacin (3-quinolinecarboxylic acid,
1-ethyl-6-fluoro-1,4-di- hydro-7-(4-methyl-1-piperazinyl)-4-oxo-),
pipemidic acid (pyrido[2,3-d]pyrimidine-6-carboxylic acid,
8-ethyl-5,8-dihydro-5-oxo-2-(- 1-piperazinyl)-), pirarubicin
(5,12-naphthacenedione,
10-[[3-amino-2,3,6-trideoxy-4-O-(tetrahydro-2H-pyran-2-yl)-alpha-L-lyxo-h-
exopyranosyl]oxy]-7,8,9,10-tetrahydro-6,8,11-trihydroxy-8-(hydroxyacetyl)--
1-methoxy-, [8S-[8 alpha,10 alpha(S*)]]-), sparfloxacin
(3-quinolinecarboxylic acid,
5-amino-1-cyclopropyl-7-(3,5-dimethyl-1-pipe- razinyl
)-6,8-difluoro-1,4-dihydro-4-oxo-, cis-), AVE-6971, cinoxacin
([1,3]dioxolo[4,5-g]cinnoline-3-carboxylic acid,
1-ethyl-1,4-dihydro-4-ox- o-), or an analogue or derivative
thereof).
[0393] 55) Angiotensin I Converting Enzyme Inhibitor
[0394] In another embodiment, the pharmacologically active compound
is an angiotensin I converting enzyme inhibitor (e.g., ramipril
(cyclopenta[b]pyrrole-2-carboxylic acid,
1-[2-[[1-(ethoxycarbonyl)-3-phen-
ylpropyl]amino]-1-oxopropyl]octahydro-, [2S-[1[R*(R*)],2 alpha,
3a.beta., 6a.beta.]]-), trandolapril (1H-indole-2-carboxylic acid,
1-[2-[(1-carboxy-3-phenylpropyl)amino]-1-oxopropyl]octahydro-,
[2S-[1[R*(R*)],2 alpha,3a alpha,7a.beta.]]-), fasidotril
(L-alanine,
N-[(2S)-3-(acetylthio)-2-(1,3-benzodioxol-5-ylmethyl)-1-oxopropyl]-,
phenylmethyl ester), cilazapril
(6H-pyridazino[1,2-a][1,2]diazepine-1-car- boxylic acid,
9-[[1-(ethoxycarbonyl)-3-phenylpropyl]amino]octahydro-10-oxo- -,
[1S-[1 alpha, 9 alpha(R*)]]-), ramipril
(cyclopenta[b]pyrrole-2-carboxy- lic acid,
1-[2-[[1-(ethoxycarbonyl)-3-phenylpropyl]amino]-1-oxopropyl]octa-
hydro-, [2S-[1[R*(R*)], 2 alpha,3a.beta.,6a.beta.]]-, or an
analogue or derivative thereof).
[0395] 56). Angiotensin II Antagonist
[0396] In another embodiment, the pharmacologically active compound
is an angiotensin II antagonist (e.g., HR-720
(1H-imidazole-5-carboxylic acid,
2-butyl-4-(methylthio)-1-[[2'-[[[(propylamino)carbonyl]amino]sulfonyl][1,-
1'-biphenyl]-4-yl]methyl]-, dipotassium salt, or an analogue or
derivative thereof).
[0397] 57) Enkephalinase Inhibitor
[0398] In another embodiment, the pharmacologically active compound
is an enkephalinase inhibitor (e.g., Aventis 100240
(pyrido[2,1-a][2]benzazepin- e-4-carboxylic acid,
7-[[2-(acetylthio)-1-oxo-3-phenylpropyl]amino]-1,2,3,-
4,6,7,8,12b-octahydro-6-oxo-, [4S-[4 alpha, 7
alpha(R*),12b.beta.]]-), AVE-7688, or an analogue or derivative
thereof).
[0399] 58) Peroxisome Proliferator-Activated Receptor Gamma Agonist
Insulin Sensitizer
[0400] In another embodiment, the pharmacologically active compound
is peroxisome proliferator-activated receptor gamma agonist insulin
sensitizer (e.g., rosiglitazone maleate (2,4-thiazolidinedione,
5-((4-(2-(methyl-2-pyridinylamino)ethoxy)phenyl)methyl)-,
(Z)-2-butenedioate (1:1), farglitazar (GI-262570, GW-2570, GW-3995,
GW-5393, GW-9765), LY-929, LY-519818, LY-674, or LSN-862), or an
analogue or derivative thereof).
[0401] 59) Protein Kinase C Inhibitor
[0402] In another embodiment, the pharmacologically active compound
is a protein kinase C inhibitor, such as ruboxistaurin mesylate
(9H,18H-5,21:12,17-dimethenodibenzo(e,k)pyrrolo(3,4-h)(1,4,13)oxadiazacyc-
lohexadecine-18,20(19H)-dione,9-((dimethylamino)methyl)-6,7,10,11-tetrahyd-
ro-, (S)-), safingol (1,3-octadecanediol, 2-amino-, [S-(R*,R*)]-),
or enzastaurin hydrochloride (1H-pyrole-2,5-dione,
3-(1-methyl-1H-indol-3-yl-
)-4-[1-[1-(2-pyridinylmethyl)-4-piperidinyl]-1H-indol-3-yl]-,
monohydrochloride), or an analogue or derivative thereof.
[0403] 60) ROCK (Rho-Associated Kinase) Inhibitors
[0404] In another embodiment, the pharmacologically active compound
is a ROCK (rho-associated kinase) inhibitor, such as Y-27632,
HA-1077, H-1152 and
4-1-(aminoalkyl)-N-(4-pyridyl)cyclohexanecarboxamide or an analogue
or derivative thereof.
[0405] 61) CXCR3 Inhibitors
[0406] In another embodiment, the pharmacologically active compound
is a CXCR3 inhibitor such as T-487, T0906487 or analogue or
derivative thereof.
[0407] 62) Itk Inhibitors
[0408] In another embodiment, the pharmacologically active compound
is an Itk inhibitor such as BMS-509744 or an analogue or derivative
thereof.
[0409] 63) Cytosolic Phospholipase A.sub.2-Alpha Inhibitors
[0410] In another embodiment, the pharmacologically active compound
is a cytosolic phospholipase A.sub.2-alpha inhibitor such as
efipladib (PLA-902) or analogue or derivative thereof.
[0411] 64) PPAR Agonist
[0412] In another embodiment, the pharmacologically active compound
is a PPAR Agonist (e.g., Metabolex ((-)-benzeneacetic acid,
4-chloro-alpha-[3-(trifluoromethyl)-phenoxy]-, 2-(acetylamino)ethyl
ester), balaglitazone
(5-(4-(3-methyl-4-oxo-3,4-dihydro-quinazolin-2-yl-m-
ethoxy)-benzyl)-thiazolidine-2,4-dione), ciglitazone
(2,4-thiazolidinedione,
5-[[4-[(1-methylcyclohexyl)methoxy]phenyl]methyl]- -), DRF-10945,
farglitazar, GSK-677954, GW-409544, GW-501516, GW-590735,
GW-590735, K-111, KRP-101, LSN-862, LY-519818, LY-674, LY-929,
muraglitazar; BMS-298585 (Glycine,
N-[(4-methoxyphenoxy)carbonyl]-N-[[4-[-
2-(5-methyl-2-phenyl-4-oxazolyl)ethoxy]phenyl]methyl]-),
netoglitazone; isaglitazone (2,4-thiazolidinedione,
5-[[6-[(2-fluorophenyl)methoxy]-2-na- phthalenyl]methyl]-), Actos
AD-4833; U-72107A (2,4-thiazolidinedione,
5-[[4-[2-(5-ethyl-2-pyridinyl)ethoxy]phenyl]methyl]-,
monohydrochloride (.+-.)-), JTT-501; PNU-182716
(3,5-Isoxazolidinedione,
4-[[4-[2-(5-methyl-2-phenyl-4-oxazolyl)ethoxy]phenyl]methyl]-),
AVANDIA (from SB Pharmco Puerto Rico, Inc. (Puerto Rico);
BRL-48482;BRL-49653;BRL- -49653c; NYRACTA and Venvia (both from
(SmithKline Beecham (United Kingdom)); tesaglitazar
((2S)-2-ethoxy-3-[4-[2-[4-[(methylsulfonyl)oxy]ph-
enyl]ethoxy]phenyl]propanoic acid), troglitazone
(2,4-Thiazolidinedione,
5-[[4-[(3,4-dihydro-6-hydroxy-2,5,7,8-tetramethyl-2H-1-benzopyran-2-yl)me-
thoxy]phenyl]methyl]-), and analogues and derivatives thereof).
[0413] 65) Immunosuppressants
[0414] In another embodiment, the pharmacologically active compound
is an immunosuppressant (e.g., batebulast (cyclohexanecarboxylic
acid, 4-[[(aminoiminomethyl)amino]methyl]-,
4-(1,1-dimethylethyl)phenyl ester, trans-), cyclomunine, exalamide
(benzamide, 2-(hexyloxy)-), LYN-001, CCI-779 (rapamycin
42-(3-hydroxy-2-(hydroxymethyl)-2-methylpropanoate)), 1726; 1726-D;
AVE-1726, or an analogue or derivative thereof).
[0415] 66) Erb Inhibitor
[0416] In another embodiment, the pharmacologically active compound
is an Erb inhibitor (e.g., canertinib dihydrochloride
(N-[4-(3-(chloro-4-fluoro-
-phenylamino)-7-(3-morpholin-4-yl-propoxy)-quinazolin-6-yl]-acrylamide
dihydrochloride), CP-724714, or an analogue or derivative
thereof).
[0417] 67) Apoptosis Agonist
[0418] In another embodiment, the pharmacologically active compound
is an apoptosis agonist (e.g., CEFLATONIN (CGX-635) (from Chemgenex
Therapeutics, Inc., Menlo Park, Calif.), CHML, LBH-589,
metoclopramide (benzamide,
4-amino-5-chloro-N-[2-(diethylamino)ethyl]-2-methoxy-), patupilone
(4,17-dioxabicyclo(14.1.0)heptadecane-5,9-dione,
7,11-dihydroxy-8,8,10,12,16-pentamethyl-3-(1-methyl-2-(2-methyl-4-thiazol-
yl)ethenyl, (1R,3S,7S,10R,11S,12S,16R)), AN-9; pivanex (butanoic
acid, (2,2-dimethyl-1-oxopropoxy)methyl ester), SL-100; SL-102;
SL-11093; SL-11098; SL-11099; SL-93; SL-98; SL-99, or an analogue
or derivative thereof).
[0419] 68) Lipocortin Agonist
[0420] In another embodiment, the pharmacologically active compound
is an lipocortin agonist (e.g., CGP-13774
(9Alpha-chloro-6Alpha-fluoro-11.beta.-
,17alpha-dihydroxy-16Alpha-methyl-3-oxo-1,4-androstadiene-17.beta.-carboxy-
lic acid-methylester-17-propionate), or analogue or derivative
thereof).
[0421] 69) VCAM-1 Antagonist
[0422] In another embodiment, the pharmacologically active compound
is a VCAM-1 antagonist (e.g., DW-908e, or an analogue or derivative
thereof).
[0423] 70) Collagen Antagonist
[0424] In another embodiment, the pharmacologically active compound
is a collagen antagonist (e.g., E-5050 (Benzenepropanamide,
4-(2,6-dimethylheptyl)-N-(2-hydroxyethyl)-.beta.-methyl-),
lufironil (2,4-Pyridinedicarboxamide, N,N'-bis(2-methoxyethyl)-),
or an analogue or derivative thereof).
[0425] 71) Alpha 2 Integrin Antagonist
[0426] In another embodiment, the pharmacologically active compound
is an alpha 2 integrin antagonist (e.g., E-7820, or an analogue or
derivative thereof).
[0427] 72) TNF Alpha Inhibitor
[0428] In another embodiment, the pharmacologically active compound
is a TNF alpha inhibitor (e.g., ethyl pyruvate, Genz-29155,
lentinan (Ajinomoto Co., Inc. (Japan)), linomide
(3-quinolinecarboxamide,
1,2-dihydro-4-hydroxy-N,1-dimethyl-2-oxo-N-phenyl-), UR-1505, or an
analogue or derivative thereof).
[0429] 73) Nitric Oxide Inhibitor
[0430] In another embodiment, the pharmacologically active compound
is a nitric oxide inhibitor (e.g., guanidioethyidisulfide, or an
analogue or derivative thereof).
[0431] 74) Cathepsin Inhibitor
[0432] In another embodiment, the pharmacologically active compound
is a cathepsin inhibitor (e.g., SB-462795 or an analogue or
derivative thereof).
[0433] Combination Therapies
[0434] In addition to incorporation of a fibrosis-inhibiting agent,
one or more other pharmaceutically active agents can be
incorporated into the present compositions to improve or enhance
efficacy. In one aspect, the composition may further include a
compound which acts to have an inhibitory effect on pathological
processes in or around the treatment site. Representative examples
of additional therapeutically active agents include, by way of
example and not limitation, anti-thrombotic agents,
anti-proliferative agents, anti-inflammatory agents, neoplastic
agents, enzymes, receptor antagonists or agonists, hormones,
antibiotics, antimicrobial agents, antibodies, cytokine inhibitors,
IMPDH (inosine monophosplate dehydrogenase) inhibitors tyrosine
kinase inhibitors, MMP inhibitors, p38 MAP kinase inhibitors,
immunosuppressants, apoptosis antagonists, caspase inhibitors, and
JNK inhibitors.
[0435] In one aspect, the present invention also provides for the
combination of an electrical device (as well as compositions and
methods for making electrical devices) that includes an
anti-fibrosing agent and an anti-infective agent, which reduces the
likelihood of infections.
[0436] Infection is a common complication of the implantation of
foreign bodies such as, for example, medical devices. Foreign
materials provide an ideal site for micro-organisms to attach and
colonize. It is also hypothesized that there is an impairment of
host defenses to infection in the microenvironment surrounding a
foreign material. These factors make medical implants particularly
susceptible to infection and make eradication of such an infection
difficult, if not impossible, in most cases.
[0437] The present invention provides agents (e.g.,
chemotherapeutic agents) that can be released from a composition,
and which have potent antimicrobial activity at extremely low
doses. A wide variety of anti-infective agents can be utilized in
combination with the present compositions. Suitable anti-infective
agents may be readily determined based the assays provided in
Example 56. Discussed in more detail below are several
representative examples of agents that can be used: (A)
anthracyclines (e.g., doxorubicin and mitoxantrone), (B)
fluoropyrimidines (e.g., 5-FU), (C) folic acid antagonists (e.g.,
methotrexate), (D) podophylotoxins (e.g., etoposide), (E)
camptothecins, (F) hydroxyureas, and (G) platinum complexes (e.g.,
cisplatin).
[0438] a) Anthracyclines
[0439] Anthracyclines have the following general structure, where
the R groups may be a variety of organic groups: 82
[0440] According to U.S. Pat. No. 5,594,158, suitable R groups are
as follows: R.sub.1 is CH.sub.3 or CH.sub.2OH; R.sub.2 is
daunosamine or H; R.sub.3 and R.sub.4 are independently one of OH,
NO.sub.2, NH.sub.2, F, Cl, Br, I, CN, H or groups derived from
these; R.sub.5 is hydrogen, hydroxyl, or methoxy; and R.sub.6-8 are
all hydrogen. Alternatively, R.sub.5 and R.sub.6 are hydrogen and
R.sub.7 and R.sub.8 are alkyl or halogen, or vice versa.
[0441] According to U.S. Pat. No. 5,843,903, R.sub.1 may be a
conjugated peptide. According to U.S. Pat. No. 4,296,105, R.sub.5
may be an ether linked alkyl group. According to U.S. Pat. No.
4,215,062, R.sub.5 may be OH or an ether linked alkyl group.
R.sub.1 may also be linked to the anthracycline ring by a group
other than C(O), such as an alkyl or branched alkyl group having
the C(O) linking moiety at its end, such as
--CH.sub.2CH(CH.sub.2--X)C(O)--R.sub.1, wherein X is H or an alkyl
group (see, e.g., U.S. Pat. No. 4,215,062). R.sub.2 may alternately
be a group linked by the functional group .dbd.N--NHC(O)--Y, where
Y is a group such as a phenyl or substituted phenyl ring.
[0442] Alternately R.sub.3 may have the following structure: 83
[0443] in which R.sub.9 is OH either in or out of the plane of the
ring, or is a second sugar moiety such as R.sub.3. R.sub.10 may be
H or form a secondary amine with a group such as an aromatic group,
saturated or partially saturated 5 or 6 membered heterocyclic
having at least one ring nitrogen (see U.S. Pat. No. 5,843,903).
Alternately, R.sub.10 may be derived from an amino acid, having the
structure --C(O)CH(NHR.sub.11)(R.s- ub.12), in which R.sub.11 is H,
or forms a C.sub.3-4 membered alkylene with R.sub.12. R.sub.12 may
be H, alkyl, aminoalkyl, amino, hydroxyl, mercapto, phenyl, benzyl
or methylthio (see U.S. Pat. No. 4,296,105).
[0444] Exemplary anthracyclines are doxorubicin, daunorubicin,
idarubicin, epirubicin, pirarubicin, zorubicin, and carubicin.
Suitable compounds have the structures:
23 84 R.sub.1 R.sub.2 R.sub.3 Doxorubicin: OCH.sub.3 C(O)CH.sub.2OH
OH out of ring plane Epirubicin: OCH.sub.3 C(O)CH.sub.2OH OH in
ring plane (4' epimer of doxorubicin) Daunorub- OCH.sub.3
C(O)CH.sub.3 OH out of ring icin: plane Idarubicin: H C(O)CH.sub.3
OH out of ring plane Pirarubicin: OCH.sub.3 C(O)CH.sub.2OH 85
Zorubicin: OCH.sub.3 C(CH.sub.3)(.dbd.N)NHC(O)C.sub.6H.sub.5 OH
Carubicin: OH C(O)CH.sub.3 OH ouyr of ring plane
[0445] Other suitable anthracyclines are anthramycin, mitoxantrone,
menogaril, nogalamycin, aclacinomycin A, olivomycin A, chromomycin
A.sub.3, and plicamycin having the structures:
24 86 87 R.sub.1 R.sub.2 R.sub.3 R.sub.4 Olivomycin A
COCH(CH.sub.3).sub.2 CH.sub.3 COCH.sub.3 H Chromomycin A.sub.3
COCH.sub.3 CH.sub.3 COCH.sub.3 CH.sub.3 Plicamycin H H H CH.sub.3
R.sub.1 R.sub.2 R.sub.3 Menogaril H OCH.sub.3 H Nogalamycin O-sugar
H COCH.sub.3 88 89
[0446] Other representative anthracyclines include, FCE 23762, a
doxorubicin derivative (Quaglia et al., J. Liq. Chromatogr.
17(18):3911-3923, 1994), annamycin (Zou et al., J. Pharm. Sci.
82(11):1151-1154, 1993), ruboxyl (Rapoport et al., J. Controlled
Release 58(2):153-162, 1999), anthracycline disaccharide
doxorubicin analogue (Pratesi et al., Clin. Cancer Res.
4(11):2833-2839, 1998), N-(trifluoroacetyl)doxorubicin and
4'-O-acetyl-N-(trifluoroacetyl)doxorub- icin (Berube & Lepage,
Synth. Commun. 28(6):11109-1116, 1998), 2-pyrrolinodoxorubicin
(Nagy et al., Proc. Nat'l Acad. Sci. U.S.A. 95(4):1794-1799, 1998),
disaccharide doxorubicin analogues (Arcamone et al., J. Nat'l
Cancer Inst. 89(16): 1217-1223, 1997),
4-demethoxy-7-O-[2,6-dideoxy-4-O-(2,3,6-trideoxy-3-amino-.alpha.-L-lyxo-h-
exopyranosyl)-.alpha.-L-lyxo-hexopyranosyl]-adriamicinone
doxorubicin disaccharide analogue (Monteagudo et al., Carbohydr.
Res. 300(1):11-16, 1997), 2-pyrrolinodoxorubicin (Nagy et al.,
Proc. Nat'l Acad. Sci. U.S.A. 94(2):652-656, 1997), morpholinyl
doxorubicin analogues (Duran et al., Cancer Chemother. Pharmacol.
38(3):210-216, 1996), enaminomalonyl-.beta.-alanine doxorubicin
derivatives (Seitz et al., Tetrahedron Lett. 36(9):1413-16, 1995),
cephalosporin doxorubicin derivatives (Vrudhula et al., J. Med.
Chem. 38(8):1380-5, 1995), hydroxyrubicin (Solary et al., Int. J.
Cancer 58(1):85-94, 1994), methoxymorpholino doxorubicin derivative
(Kuhl et al., Cancer Chemother. Pharmacol. 33(1):10-16, 1993),
(6-maleimidocaproyl)hydrazone doxorubicin derivative (Wiliner et
al., Bioconjugate Chem. 4(6):521-7, 1993),
N-(5,5-diacetoxypent-1-yl) doxorubicin (Cherif & Farquhar, J.
Med. Chem. 35(17):3208-14, 1992), FCE 23762 methoxymorpholinyl
doxorubicin derivative (Ripamonti et al., Br. J. Cancer
65(5):703-7, 1992), N-hydroxysuccinimide ester doxorubicin
derivatives (Demant et al., Biochim. Biophys. Acta 1118(1):83-90,
1991), polydeoxynucleotide doxorubicin derivatives (Ruggiero et
al., Biochim. Biophys. Acta 1129(3):294-302, 1991), morpholinyl
doxorubicin derivatives (EPA 434960), mitoxantrone doxorubicin
analogue (Krapcho et al., J. Med. Chem. 34(8):2373-80. 1991), AD198
doxorubicin analogue (Traganos et al., Cancer Res. 51(14):3682-9,
1991), 4-demethoxy-3'-N-trifluoroacetyidoxorubicin (Horton et al.,
Drug Des. Delivery 6(2):123-9, 1990), 4'-epidoxorubicin (Drzewoski
et al., Pol. J. Pharmacol. Pharm. 40(2):159-65, 1988; Weenen et
al., Eur. J. Cancer Clin. Oncol. 20(7):919-26, 1984), alkylating
cyanomorpholino doxorubicin derivative (Scudder et al., J. Nat'l
Cancer Inst. 80(16): 1294-8, 1988), deoxydihydroiodooxorubicin (EPA
275966), adriblastin (Kalishevskaya etal., Vestn. Mosk. Univ.,
16(Biol. 1):21-7, 1988), 4'-deoxydoxorubicin (Schoeizel et al.,
Leuk. Res. 10(12):1455-9, 1986),
4-demethyoxy-4'-o-methyldoxorubicin (Giuliani et al., Proc. Int.
Congr. Chemother. 16:285-70-285-77, 1983),
3'-deamino-3'-hydroxydoxorubic- in (Horton et al., J. Antibiot.
37(8):853-8, 1984), 4-demethyoxy doxorubicin analogues (Barbieri et
al., Drugs Exp. Clin. Res. 10(2):85-90, 1984), N-L-leucyl
doxorubicin derivatives (Trouet et al., Anthracyclines (Proc. Int.
Symp. Tumor Pharmacother.), 179-81, 1983),
3'-deamino-3'-(4-methoxy-1-piperidinyl) doxorubicin derivatives
(U.S. Pat. No. 4,314,054), 3'-deamino-3'-(4-mortholinyl)
doxorubicin derivatives (U.S. Pat. No. 4,301,277),
4'-deoxydoxorubicin and 4'-omethyidoxorubicin (Giuliani et al.,
Int. J. Cancer 27(1):5-13, 1981), aglycone doxorubicin derivatives
(Chan & Watson, J. Pharm. Sci. 67(12):1748-52, 1978), SM 5887
(Pharma Japan 1468:20, 1995), MX-2 (Pharma Japan 1420:19, 1994),
4'-deoxy-13(S)-dihydro-4'-iododoxorubicin (EP 275966), morpholinyl
doxorubicin derivatives (EPA 434960),
3'-deamino-3'-(4-methoxy-1-piperidinyl) doxorubicin derivatives
(U.S. Pat. No. 4,314,054), doxorubicin-14-valerate,
morpholinodoxorubicin (U.S. Pat. No. 5,004,606),
3'-deamino-3'-(3"-cyano-4"-morpholinyl doxorubicin;
3'-deamino-3'-(3"-cyano-4"-morpholinyl)-13-dihydoxorubicin;
(3'-deamino-3'-(3"-cyano-4"-morpholinyl) daunorubicin;
3'-deamino-3'-(3"-cyano-4"-morpholinyl)-3-dihydrodaunorubicin; and
3'-deamino-3'-(4"-morpholinyl-5-iminodoxorubicin and derivatives
(U.S. Pat. No. 4,585,859), 3'-deamino-3'-(4-methoxy-1-piperidinyl)
doxorubicin derivatives (U.S. Pat. No. 4,314,054) and
3-deamino-3-(4-morpholinyl) doxorubicin derivatives (U.S. Pat. No.
4,301,277).
[0447] b) Fluoropyrimidine Analogues
[0448] In another aspect, the therapeutic agent is a
fluoropyrimidine analog, such as 5-fluorouracil, or an analogue or
derivative thereof, including carmofur, doxifluridine, emitefur,
tegafur, and floxuridine. Exemplary compounds have the
structures:
25 90 R.sub.1 R.sub.2 5-Fluorouracil H H Carmofur
C(O)NH(CH.sub.2).sub.5CH.sub.3 H Doxifluridine A.sub.1 H
Floxuridine A.sub.2 H Emitefur CH.sub.2OCH.sub.2CH.sub.3 B Tegafur
C H 91 92
[0449] Other suitable fluoropyrimidine analogues include 5-FudR
(5-fluoro-deoxyuridine), or an analogue or derivative thereof,
including 5-iododeoxyuridine (5-ludR), 5-bromodeoxyuridine
(5-BudR), fluorouridine triphosphate (5-FUTP), and
fluorodeoxyuridine monophosphate (5-dFUMP). Exemplary compounds
have the structures:
26 93 5-Fluoro-2'-deoxyuridine: R = F 5-Bromo-2'-deoxyuridine: R =
Br 5-Iodo-2'-deoxyuridine: R = I
[0450] Other representative examples of fluoropyrimidine analogues
include N3-alkylated analogues of 5-fluorouracil (Kozai et al., J.
Chem. Soc., Perkin Trans. 1(19):3145-3146, 1998), 5-fluorouracil
derivatives with 1,4-oxaheteroepane moieties (Gomez et al.,
Tetrahedron 54(43):13295-13312, 1998), 5-fluorouracil and
nucleoside analogues (Li, Anticancer Res. 17(1A):21-27, 1997), cis-
and trans-5-fluoro-5,6-dihydro-- 6-alkoxyuracil (Van der Wilt et
al., Br. J. Cancer 68(4):702-7, 1993), cyclopentane 5-fluorouracil
analogues (Hronowski & Szarek, Can. J. Chem. 70(4):1162-9,
1992), A-OT-fluorouracil (Zhang et al., Zongguo Yiyao Gongye Zazhi
20(11):513-15, 1989), N4-trimethoxybenzoyl-5'-deoxy-5-fluoro-
cytidine and 5'-deoxy-5-fluorouridine (Miwa et al., Chem. Pharm.
Bull. 38(4):998-1003, 1990), 1-hexylcarbamoyl-5-fluorouracil (Hoshi
et al., J. Pharmacobio-Dun. 3(9):478-81, 1980; Maehara et al.,
Chemotherapy (Basel) 34(6):484-9, 1988), B-3839 (Prajda et al., In
Vivo 2(2):151-4, 1988), uracil-1-(2-tetrahydrofuryl)-5-fluorouracil
(Anai et al., Oncology 45(3):144-7, 1988),
1-(2'-deoxy-2'-fluoro-.beta.-D-arabinofuranosyl)-5-fl- uorouracil
(Suzuko et al., Mol. Pharmacol. 31(3):301-6, 1987), doxifluridine
(Matuura et al., Oyo Yakuri 29(5):803-31, 1985),
5'-deoxy-5-fluorouridine (Bollag & Hartmann, Eur. J. Cancer
16(4):427-32, 1980), 1-acetyl-3-O-toluyl-5-fluorouracil (Okada,
Hiroshima J. Med. Sci. 28(1):49-66, 1979),
5-fluorouracil-m-formylbenzene-sulfonate (JP 55059173),
N'-(2-furanidyl)-5-fluorouracil (JP 53149985) and
1-(2-tetrahydrofuryl)-5-fluorouracil (JP 52089680).
[0451] These compounds are believed to function as therapeutic
agents by serving as antimetabolites of pyrimidine.
[0452] c) Folic Acid Antagonists
[0453] In another aspect, the therapeutic agent is a folic acid
antagonist, such as methotrexate or derivatives or analogues
thereof, including edatrexate, trimetrexate, raltitrexed,
piritrexim, denopterin, tomudex, and pteropterin. Methotrexate
analogues have the following general structure: 94
[0454] The identity of the R group may be selected from organic
groups, particularly those groups set forth in U.S. Pat. Nos.
5,166,149 and 5,382,582. For example, R.sub.1 may be N, R.sub.2 may
be N or C(CH.sub.3), R.sub.3 and R.sub.3' may H or alkyl, e.g.,
CH.sub.3, R.sub.4 may be a single bond or NR, where R is H or alkyl
group. R.sub.5,6,8 may be H, OCH.sub.3, or alternately they can be
halogens or hydro groups. R.sub.7 is a side chain of the general
structure: 95
[0455] wherein n=1 for methotrexate, n=3 for pteropterin. The
carboxyl groups in the side chain may be esterified or form a salt
such as a Zn.sup.2+ salt. R.sub.9 and R.sub.10 can be NH.sub.2 or
may be alkyl substituted.
[0456] Exemplary folic acid antagonist compounds have the
structures:
27 96 R.sub.0 R.sub.1 R.sub.12 R.sub.3 R.sub.4 R.sub.5 R.sub.6
R.sub.7 R.sub.8 Methotrexate NH.sub.2 N N H N(CH.sub.3) H H A (n =
1) H Edatrexate NH.sub.2 N N H CH(CH.sub.2CH.sub.3) H H A (n = 1) H
Trimetrexate NH.sub.2 CH C(CH.sub.3) H NH H OCH.sub.3 OCH.sub.3
OCH.sub.3 Pteropterin OH N N H NH H H A (n = 3) H Denopterin OH N N
CH.sub.3 N(CH.sub.3) H H A (n = 1) H Peritrexim NH.sub.2 N
C(CH.sub.3) H single bond OCH.sub.3 H H OCH.sub.3 97 98
[0457] Other representative examples include 6-S-aminoacyloxymethyl
mercaptopurine derivatives (Harada et al., Chem. Pharm. Bull
43(10):793-6, 1995), 6-mercaptopurine (6-MP) (Kashida et al., Biol.
Pharm. Bull. 18(11):1492-7, 1995),
7,8-polymethyleneimidazo-1,3,2-diazaph- osphorines (Nilov et al.,
Mendeleev Commun. 2:67, 1995), azathioprine (Chifotides et al., J.
Inorg. Biochem. 56(4):249-64, 1994), methyl-D-glucopyranoside
mercaptopurine derivatives (Da Silva et al., Eur. J. Med. Chem.
29(2):149-52, 1994) and s-alkynyl mercaptopurine derivatives
(Ratsino et al., Khim.-Farm. Zh. 15(8):65-7, 1981); indoline ring
and a modified ornithine or glutamic acid-bearing methotrexate
derivatives (Matsuoka et al., Chem. Pharm. Bull. 45(7):1146-1150,
1997), alkyl-substituted benzene ring C bearing methotrexate
derivatives (Matsuoka et al., Chem. Pharm. Bull. 44(12):2287-2293,
1996), benzoxazine or benzothiazine moiety-bearing methotrexate
derivatives (Matsuoka et al., J. Med. Chem. 40(1):105-111, 1997),
10-deazaaminopterin analogues (DeGraw et al., J. Med. Chem.
40(3):370-376, 1997), 5-deazaaminopterin and
5,10-dideazaaminopterin methotrexate analogues (Piper et al., J.
Med. Chem. 40(3):377-384, 1997), indoline moiety-bearing
methotrexate derivatives (Matsuoka et al., Chem. Pharm. Bull.
44(7):1332-1337, 1996), lipophilic amide methotrexate derivatives
(Pignatello et al., World Meet. Pharm. Biopharm. Pharm. Technol.,
563-4, 1995), L-threo-(2S,4S)-4-fluorog- lutamic acid and
DL-3,3-difluoroglutamic acid-containing methotrexate analogues
(Hart et al., J. Med. Chem. 39(1):56-65, 1996), methotrexate
tetrahydroquinazoline analogue (Gangjee, et al., J. Heterocycl.
Chem. 32(1):243-8, 1995), N-(.alpha.-aminoacyl) methotrexate
derivatives (Cheung et al., Pteridines 3(1-2):101-2, 1992), biotin
methotrexate derivatives (Fan et al., Pteridines 3(1-2):131-2,
1992), D-glutamic acid or D-erythrou, threo-4-fluoroglutamic acid
methotrexate analogues (McGuire et al., Biochem. Pharmacol.
42(12):2400-3, 1991), .beta.,.gamma.-methano methotrexate analogues
(Rosowsky et al., Pteridines 2(3):133-9, 1991), 10-deazaaminopterin
(10-EDAM) analogue (Braakhuis et al., Chem. Biol. Pteridines, Proc.
Int. Symp. Pteridines Folic Acid Deriv., 1027-30, 1989),
.gamma.-tetrazole methotrexate analogue (Kalman et al., Chem. Biol.
Pteridines, Proc. Int. Symp. Pteridines Folic Acid Deriv., 1154-7,
1989), N-(L-.alpha.-aminoacyl)metho- trexate derivatives (Cheung et
al., Heterocycles 28(2):751-8, 1989), meta and ortho isomers of
aminopterin (Rosowsky et al., J. Med. Chem. 32(12):2582, 1989),
hydroxymethylmethotrexate (DE 267495), .gamma.-fluoromethotrexate
(McGuire et al., Cancer Res. 49(16):4517-25, 1989), polyglutamyl
methotrexate derivatives (Kumar et al., Cancer Res. 46(10):5020-3,
1986), gem-diphosphonate methotrexate analogues (WO 88/06158),
.alpha.- and .gamma.-substituted methotrexate analogues (Tsushima
et al., Tetrahedron 44(17):5375-87, 1988), 5-methyl-5-deaza
methotrexate analogues (U.S. Pat. No. 4,725,687),
N.delta.-acyl-N.alpha.-- (4-amino-4-deoxypteroyl)-L-ornithine
derivatives (Rosowsky et al., J. Med. Chem. 31(7):1332-7, 1988),
8-deaza methotrexate analogues (Kuehl et al., Cancer Res.
48(6):1481-8, 1988), acivicin methotrexate analogue (Rosowsky et
al., J. Med. Chem. 30(8):1463-9, 1987), polymeric platinol
methotrexate derivative (Carraher et al., Polym. Sci. Technol.
(Plenum), 35(Adv. Biomed. Polym.):311-24, 1987),
methotrexate-.gamma.-dimyristoylph- ophatidylethanolamine (Kinsky
et al., Biochim. Biophys. Acta 917(2):211-18, 1987), methotrexate
polyglutamate analogues (Rosowsky et al., Chem. Biol. Pteridines,
Pteridines Folic Acid Deriv., Proc. Int. Symp. Pteridines Folic
Acid Deriv.: Chem., Biol. Clin. Aspects: 985-8, 1986),
poly-.gamma.-glutamyl methotrexate derivatives (Kisliuk et al.,
Chem. Biol. Pteridines, Pteridines Folic Acid Deriv., Proc. Int.
Symp. Pteridines Folic Acid Deriv.: Chem., Biol. Clin. Aspects:
989-92, 1986), deoxyuridylate methotrexate derivatives (Webber et
al., Chem. Biol. Pteridines, Pteridines Folic Acid Deriv., Proc.
Int. Symp. Pteridines Folic Acid Deriv.: Chem., Biol. Clin.
Aspects: 659-62, 1986), iodoacetyl lysine methotrexate analogue
(Delcamp et al., Chem. Biol. Pteridines, Pteridines Folic Acid
Deriv., Proc. Int. Symp. Pteridines Folic Acid Deriv.: Chem., Biol.
Clin. Aspects: 807-9, 1986), 2,.omega.-diaminoalkano- id
acid-containing methotrexate analogues (McGuire et al., Biochem.
Pharmacol. 35(15):2607-13, 1986), polyglutamate methotrexate
derivatives (Kamen & Winick, Methods Enzymol. 122(Vitam.
Coenzymes, Pt. G):339-46, 1986), 5-methyl-5-deaza analogues (Piper
et al., J. Med. Chem. 29(6):1080-7, 1986), quinazoline methotrexate
analogue (Mastropaolo et al., J. Med. Chem. 29(1):155-8, 1986),
pyrazine methotrexate analogue (Lever & Vestal, J. Heterocycl.
Chem. 22(1):5-6, 1985), cysteic acid and homocysteic acid
methotrexate analogues (4,490,529), .gamma.-tert-butyl methotrexate
esters (Rosowsky et al., J. Med. Chem. 28(5):660-7, 1985),
fluorinated methotrexate analogues (Tsushima et al., Heterocycles
23(1):45-9, 1985), folate methotrexate analogue (Trombe, J.
Bacteriol. 160(3):849-53, 1984), phosphonoglutamic acid analogues
(Sturtz & Guillamot, Eur. J. Med. Chem.--Chim. Ther.
19(3):267-73, 1984), poly (L-lysine) methotrexate conjugates
(Rosowsky et al., J. Med. Chem. 27(7):888-93, 1984), dilysine and
trilysine methotrexate derivates (Forsch & Rosowsky, J. Org.
Chem. 49(7):1305-9, 1984), 7-hydroxymethotrexate (Fabre et al.,
Cancer Res. 43(10):4648-52, 1983), poly-.gamma.-glutamyl
methotrexate analogues (Piper & Montgomery, Adv. Exp. Med.
Biol., 163(Folyl Antifolyl Polyglutamates):95-100, 1983),
3',5'-dichloromethotrexate (Rosowsky & Yu, J. Med. Chem.
26(10):1448-52, 1983), diazoketone and chloromethylketone
methotrexate analogues (Gangjee et al., J. Pharm. Sci.
71(6):717-19, 1982), 10-propargylaminopterin and alkyl methotrexate
homologs (Piper et al., J. Med. Chem. 25(7):877-80, 1982), lectin
derivatives of methotrexate (Lin et al., JNCI 66(3):523-8, 1981),
polyglutamate methotrexate derivatives (Galivan, Mol. Pharmacol.
17(1):105-10, 1980), halogentated methotrexate derivatives (Fox,
JNCI 58(4):J955-8, 1977), 8-alkyl-7,8-dihydro analogues (Chaykovsky
et al., J. Med. Chem. 20(10):J1323-7, 1977), 7-methyl methotrexate
derivatives and dichloromethotrexate (Rosowsky & Chen, J. Med.
Chem. 17(12):J1308-11, 1974), lipophilic methotrexate derivatives
and 3',5'-dichloromethotrexate (Rosowsky, J. Med. Chem. 16(10):J1
190-3, 1973), deaza amethopterin analogues (Montgomery et al., Ann.
N.Y. Acad. Sci. 186:J227-34, 1971), MX068 (Pharma Japan, 1658:18,
1999) and cysteic acid and homocysteic acid methotrexate analogues
(EPA 0142220);
[0458] These compounds are believed to act as antimetabolites of
folic acid.
[0459] d) Podophyllotoxins
[0460] In another aspect, the therapeutic agent is a
podophyllotoxin, or a derivative or an analogue thereof. Exemplary
compounds of this type are etoposide or teniposide, which have the
following structures:
28 99 R Etoposide CH.sub.3 Teniposide 100
[0461] Other representative examples of podophyllotoxins include
Cu(ll)-VP-16 (etoposide) complex (Tawa et al., Bioorg. Med. Chem.
6(7):1003-1008, 1998), pyrrolecarboxamidino-bearing etoposide
analogues (Ji et al., Bioorg. Med. Chem. Lett. 7(5):607-612, 1997),
4.beta.-amino etoposide analogues (Hu, University of North Carolina
Dissertation, 1992), .gamma.-lactone ring-modified arylamino
etoposide analogues (Zhou et al., J. Med. Chem. 37(2):287-92,
1994), N-glucosyl etoposide analogue (Allevi et al., Tetrahedron
Lett. 34(45):7313-16, 1993), etoposide A-ring analogues (Kadow et
al., Bioorg. Med. Chem. Lett. 2(1):17-22, 1992),
4'-deshydroxy-4'-methyl etoposide (Saulnier et al., Bioorg. Med.
Chem. Lett. 2(10):1213-18, 1992), pendulum ring etoposide analogues
(Sinha et al., Eur. J. Cancer 26(5):590-3, 1990) and E-ring desoxy
etoposide analogues (Saulnier et al., J. Med. Chem. 32(7):1418-20,
1989).
[0462] These compounds are believed to act as topoisomerase II
inhibitors and/or DNA cleaving agents.
[0463] e) Camptothecins
[0464] In another aspect, the therapeutic agent is camptothecin, or
an analogue or derivative thereof. Camptothecins have the following
general structure. 101
[0465] In this structure, X is typically O, but can be other
groups, e.g., NH in the case of 21-lactam derivatives. R.sub.1 is
typically H or OH, but may be other groups, e.g., a terminally
hydroxylated C.sub.1-3 alkane. R.sub.2 is typically H or an amino
containing group such as (CH.sub.3).sub.2NHCH.sub.2, but may be
other groups e.g., NO.sub.2, NH.sub.2, halogen (as disclosed in,
e.g., U.S. Pat. No. 5,552,156) or a short alkane containing these
groups. R.sub.3 is typically H or a short alkyl such as
C.sub.2H.sub.5. R.sub.4 is typically H but may be other groups,
e.g., a methylenedioxy group with R.sub.1.
[0466] Exemplary camptothecin compounds include topotecan,
irinotecan (CPT-11), 9-aminocamptothecin, 21
-lactam-20(S)-camptothecin, 10,11 -methylenedioxycamptothecin,
SN-38, 9-nitrocamptothecin, 10-hydroxycamptothecin. Exemplary
compounds have the structures:
29 102 R.sub.1 R.sub.2 R.sub.3 Camptothecin: H H H Topotecan: OH
(CH.sub.3).sub.2NHCH.sub.2 H SN-38: OH H C.sub.2H.sub.5 X: O for
most analogs, NH for 21-lactam analogs
[0467] Camptothecins have the five rings shown here. The ring
labeled E must be intact (the lactone rather than carboxylate form)
for maximum activity and minimum toxicity.
[0468] Camptothecins are believed to function as topoisomerase I
inhibitors and/or DNA cleavage agents.
[0469] f) Hydroxyureas
[0470] The therapeutic agent of the present invention may be a
hydroxyurea. Hydroxyureas have the following general structure:
103
[0471] Suitable hydroxyureas are disclosed in, for example, U.S.
Pat. No. 6,080,874, wherein R.sub.1 is: 104
[0472] and R.sub.2 is an alkyl group having 1-4 carbons and R.sub.3
is one of H, acyl, methyl, ethyl, and mixtures thereof, such as a
methylether.
[0473] Other suitable hydroxyureas are disclosed in, e.g., U.S.
Pat. No. 5,665,768, wherein R.sub.1 is a cycloalkenyl group, for
example N-[3-[5-(4-fluorophenylthio)-furyl]-2-cyclopenten-1
-yl]N-hydroxyurea; R.sub.2 is H or an alkyl group having 1 to 4
carbons and R.sub.3 is H; X is H or a cation.
[0474] Other suitable hydroxyureas are disclosed in, e.g., U.S.
Pat. No. 4,299,778, wherein R.sub.1 is a phenyl group substituted
with one or more fluorine atoms; R.sub.2 is a cyclopropyl group;
and R.sub.3 and X is H.
[0475] Other suitable hydroxyureas are disclosed in, e.g., U.S.
Pat. No. 5,066,658, wherein R.sub.2 and R.sub.3 together with the
adjacent nitrogen form: 105
[0476] wherein m is 1 or 2, n is 0-2 and Y is an alkyl group.
[0477] In one aspect, the hydroxyurea has the structure: 106
[0478] These compounds are thought to function by inhibiting DNA
synthesis.
[0479] g) Platinum complexes
[0480] In another aspect, the therapeutic agent is a platinum
compound. In general, suitable platinum complexes may be of Pt(II)
or Pt(IV) and have this basic structure: 107
[0481] wherein X and Y are anionic leaving groups such as sulfate,
phosphate, carboxylate, and halogen; R.sub.1 and R.sub.2 are alkyl;
amine, amino alkyl any may be further substituted, and are
basically inert or bridging groups. For Pt(II) complexes Z.sub.1
and Z.sub.2 are non-existent. For Pt(IV) Z.sub.1 and Z.sub.2 may be
anionic groups such as halogen, hydroxy, carboxylate, ester,
sulfate or phosphate. See, e.g., U.S. Pat. Nos. 4,588,831 and
4,250,189.
[0482] Suitable platinum complexes may contain multiple Pt atoms.
See, e.g., U.S. Pat. Nos. 5,409,915 and 5,380,897. For example
bisplatinum and triplatinum complexes of the type: 108
[0483] Exemplary platinum compounds are cisplatin, carboplatin,
oxaliplatin, and miboplatin having the structures: 109
[0484] Other representative platinum compounds include
(CPA).sub.2Pt[DOLYM] and (DACH)Pt[DOLYM] cisplatin (Choi et al.,
Arch. Pharmacal Res. 22(2):151-156, 1999),
Cis-[PtCl.sub.2(4,7-H-5-methyl-7-oxo-
]1,2,4[triazolo[1,5-a]pyrimidine).sub.2] (Navarro et al., J. Med.
Chem. 41(3):332-338, 1998),
[Pt(cis-1,4-DACH)(trans-Cl.sub.2)(CBDCA)].1/2 MeOH cisplatin
(Shamsuddin et al., Inorg. Chem. 36(25):5969-5971, 1997),
4-pyridoxate diammine hydroxy platinum (Tokunaga et al., Pharm.
Sci. 3(7):353-356, 1997), Pt(II) . . . Pt(II)
(Pt.sub.2[NHCHN(C(CH.sub.2)(CH.s- ub.3))].sub.4) (Navarro et al.,
Inorg. Chem. 35(26):7829-7835, 1996), 254-S cisplatin analogue
(Koga et al., Neurol. Res. 18(3):244-247, 1996), o-phenylenediamine
ligand bearing cisplatin analogues (Koeckerbauer & Bednarski,
J. Inorg. Biochem. 62(4):281-298, 1996), trans,
cis-[Pt(OAc).sub.2l.sub.2(en)] (Kratochwil et al., J. Med. Chem.
39(13):2499-2507, 1996), estrogenic 1,2-diarylethylenediamine
ligand (with sulfur-containing amino acids and glutathione) bearing
cisplatin analogues (Bednarski, J. Inorg. Biochem. 62(1):75, 1996),
cis-1,4-diaminocyclohexane cisplatin analogues (Shamsuddin et al.,
J. Inorg. Biochem. 61(4):291-301, 1996), 5' orientational isomer of
cis-[Pt(NH.sub.3)(4-aminoTEMP-O){d(GpG)}] (Dunham & Lippard, J.
Am. Chem. Soc. 117(43):10702-12, 1995), chelating diamine-bearing
cisplatin analogues (Koeckerbauer & Bednarski, J. Pharm. Sci.
84(7):819-23, 1995), 1,2-diarylethyleneamine ligand-bearing
cisplatin analogues (Otto et al., J. Cancer Res. Clin. Oncol.
121(1):31-8, 1995), (ethylenediamine)platinum- (II) complexes
(Pasini et al., J. Chem. Soc., Dalton Trans. 4:579-85, 1995),
Cl-973 cisplatin analogue (Yang et al., Int. J. Oncol.
5(3):597-602, 1994), cis-diaminedichloroplatinum(II) and its
analogues
cis-1,1-cyclobutanedicarbosylato(2R)-2-methyl-1,4-butanediamineplatinum(I-
I) and cis-diammine(glycolato)platinum (Claycamp & Zimbrick, J.
Inorg. Biochem. 26(4):257-67, 1986; Fan et al., Cancer Res.
48(11):3135-9, 1988; Heiger-Bernays et al., Biochemistry
29(36):8461-6, 1990; Kikkawa et al., J. Exp. Clin. Cancer Res.
12(4):233-40, 1993; Murray et al., Biochemistry 31(47):11812-17,
1992; Takahashi et al., Cancer Chemother. Pharmacol. 33(1):31-5,
1993), cis-amine-cyclohexylamine-dichloroplatinum(II) (Yoshida et
al., Biochem. Pharmacol. 48(4):793-9, 1994), gem-diphosphonate
cisplatin analogues (FR 2683529),
(meso-1,2-bis(2,6-dichloro-4-hydroxyplenyl)ethylenediamine)
dichloroplatinum(II) (Bednarski et al., J. Med. Chem.
35(23):4479-85, 1992), cisplatin analogues containing a tethered
dansyl group (Hartwig et al., J. Am. Chem. Soc. 114(21):8292-3,
1992), platinum(II) polyamines (Siegmann et al., Inorg.
Met.-Containing Polym. Mater., (Proc. Am. Chem. Soc. Int. Symp.),
335-61, 1990), cis-(3H)dichloro(ethylenediamine)platinu- m(II)
(Eastman, Anal. Biochem. 197(2):311-15, 1991),
trans-diamminedichloroplatinum(II) and
cis-(Pt(NH.sub.3).sub.2(N.sub.3-cy- tosine)Cl) (Bellon &
Lippard, Biophys. Chem. 35(2-3):179-88, 1990),
3H-cis-1,2-diaminocyclohexanedichloroplatinum(II) and
3H-cis-1,2-diaminocyclohexane-malonatoplatinum(II) (Oswald et al.,
Res. Commun. Chem. Pathol. Pharmacol. 64(1):41-58, 1989),
diaminocarboxylatoplatinum (EPA 296321),
trans-(D,1)-1,2-diaminocyclohexa- ne carrier ligand-bearing
platinum analogues (Wyrick & Chaney, J. Labelled Compd.
Radiopharm. 25(4):349-57, 1988), aminoalkylaminoanthraquinone-deri-
ved cisplatin analogues (Kitov et al., Eur. J. Med. Chem.
23(4):381-3, 1988), spiroplatin, carboplatin, iproplatin and JM40
platinum analogues (Schroyen et al., Eur. J. Cancer Clin. Oncol.
24(8):1309-12, 1988), bidentate tertiary diamine-containing
cisplatinum derivatives (Orbell et al., Inorg. Chim. Acta
152(2):125-34, 1988), platinum(II), platinum(IV) (Liu & Wang,
Shandong Yike Daxue Xuebao 24(1):35-41, 1986),
cis-diammine(1,1-cyclobutanedicarboxylato-)platinum(II)
(carboplatin, J M8) and ethylenediammine-malonatoplatinum(II)
(JM40) (Begg et al., Radiother. Oncol. 9(2):157-65, 1987), JM8 and
JM9 cisplatin analogues (Harstrick et al., Int. J. Androl. 10(1);
139-45, 1987), (NPr4)2((PtCL4).cis-(PtCl2-(NH2Me)2)) (Brammer et
al., J. Chem. Soc., Chem. Commun. 6:443-5, 1987), aliphatic
tricarboxylic acid platinum complexes (EPA 185225), and
cis-dichloro(amino acid)(tert-butylamine)plat- inum(II) complexes
(Pasini & Bersanetti, Inorg. Chim. Acta 107(4):259-67, 1985).
These compounds are thought to function by binding to DNA, i.e.,
acting as alkylating agents of DNA.
[0485] As medical implants are made in a variety of configurations
and sizes, the exact dose administered may vary with device size,
surface area, design and portions of the implant coated. However,
certain principles can be applied in methotrexate methotrexate the
application of this art. Drug dose can be calculated as a function
of dose per unit area (of the portion of the device being coated),
total drug dose administered can be measured and appropriate
surface concentrations of active drug can be determined. Regardless
of the method of application of the drug to the cardiac implant,
the preferred anticancer agents, used alone or in combination, may
be administered under the following dosing guidelines:
[0486] (a) Anthracyclines. Utilizing the anthracycline doxorubicin
as an example, whether applied as a polymer coating, incorporated
into the polymers which make up the implant components, or applied
without a carrier polymer, the total dose of doxorubicin applied to
the implant should not exceed 25 mg (range of 0.1 .mu.g to 25 mg).
In a particularly preferred embodiment, the total amount of drug
applied should be in the range of 1 .mu.g to 5 mg. The dose per
unit area (i.e., the amount of drug as a function of the surface
area of the portion of the implant to which drug is applied and/or
incorporated) should fall within the range of 0.01 .mu.g-100 .mu.g
per mm.sup.2 of surface area. In a particularly preferred
embodiment, doxorubicin should be applied to the implant surface at
a dose of 0.1 .mu.g/mm.sup.2-10 .mu.g/mm.sup.2. As different
polymer and non-polymer coatings may release doxorubicin at
differing rates, the above dosing parameters should be utilized in
combination with the release rate of the drug from the implant
surface such that a minimum concentration of 10.sup.-8-10.sup.-4 M
of doxorubicin is maintained on the surface. It is necessary to
insure that surface drug concentrations exceed concentrations of
doxorubicin known to be lethal to multiple species of bacteria and
fungi (i.e., are in excess of 10.sup.-4 M; although for some
embodiments lower concentrations are sufficient). In a preferred
embodiment, doxorubicin is released from the surface of the implant
such that anti-infective activity is maintained for a period
ranging from several hours to several months. In a particularly
preferred embodiment the drug is released in effective
concentrations for a period ranging from 1 week-6 months. It should
be readily evident based upon the discussions provided herein that
analogues and derivatives of doxorubicin (as described previously)
with similar functional activity can be utilized for the purposes
of this invention; the above dosing parameters are then adjusted
according to the relative potency of the analogue or derivative as
compared to the parent compound (e.g., a compound twice as potent
as doxorubicin is administered at half the above parameters, a
compound half as potent as doxorubicin is administered at twice the
above parameters, etc.).
[0487] Utilizing mitoxantrone as another example of an
anthracycline, whether applied as a polymer coating, incorporated
into the polymers which make up the implant, or applied without a
carrier polymer, the total dose of mitoxantrone applied should not
exceed 5 mg (range of 0.01 .mu.g to 5 mg). In a particularly
preferred embodiment, the total amount of drug applied should be in
the range of 0.1 .mu.g to 3 mg. The dose per unit area (i.e., the
amount of drug as a function of the surface area of the portion of
the implant to which drug is applied and/or incorporated) should
fall within the range of 0.01 .mu.g-20 .mu.g per mm.sup.2 of
surface area. In a particularly preferred embodiment, mitoxantrone
should be applied to the implant surface at a dose of 0.05
.mu.g/mm.sup.2-5 .mu.g/mm.sup.2. As different polymer and
non-polymer coatings will release mitoxantrone at differing rates,
the above dosing parameters should be utilized in combination with
the release rate of the drug from the implant surface such that a
minimum concentration of 10.sup.-4-10.sup.-8 M of mitoxantrone is
maintained. It is necessary to insure that drug concentrations on
the implant surface exceed concentrations of mitoxantrone known to
be lethal to multiple species of bacteria and fungi (i.e., are in
excess of 10.sup.-5 M; although for some embodiments lower drug
levels will be sufficient). In a preferred embodiment, mitoxantrone
is released from the surface of the implant such that
anti-infective activity is maintained for a period ranging from
several hours to several months. In a particularly preferred
embodiment the drug is released in effective concentrations for a
period ranging from 1 week-6 months. It should be readily evident
based upon the discussions provided herein that analogues and
derivatives of mitoxantrone (as described previously) with similar
functional activity can be utilized for the purposes of this
invention; the above dosing parameters are then adjusted according
to the relative potency of the analogue or derivative as compared
to the parent compound (e.g., a compound twice as potent as
mitoxantrone is administered at half the above parameters, a
compound half as potent as mitoxantrone is administered at twice
the above parameters, etc.).
[0488] (b) Fluoropyrimidines Utilizing the fluoropyrimidine
5-fluorouracil as an example, whether applied as a polymer coating,
incorporated into the polymers which make up the implant, or
applied without a carrier polymer, the total dose of 5-fluorouracil
applied should not exceed 250 mg (range of 1.0 .mu.g to 250 mg). In
a particularly preferred embodiment, the total amount of drug
applied should be in the range of 10 .mu.g to 25 mg. The dose per
unit area (i.e., the amount of drug as a function of the surface
area of the portion of the implant to which drug is applied and/or
incorporated) should fall within the range of 0.05 .mu.g-200 .mu.g
per mm.sup.2 of surface area. In a particularly preferred
embodiment, 5-fluorouracil should be applied to the implant surface
at a dose of 0.5 .mu.g/mm.sup.2-50 .mu.g/mm.sup.2. As different
polymer and non-polymer coatings will release 5-fluorouracil at
differing rates, the above dosing parameters should be utilized in
combination with the release rate of the drug from the implant
surface such that a minimum concentration of 10.sup.-4-10.sup.-7 M
of 5-fluorouracil is maintained. It is necessary to insure that
surface drug concentrations exceed concentrations of 5-fluorouracil
known to be lethal to numerous species of bacteria and fungi (i.e.,
are in excess of 10.sup.-4 M; although for some embodiments lower
drug levels will be sufficient). In a preferred embodiment,
5-fluorouracil is released from the implant surface such that
anti-infective activity is maintained for a period ranging from
several hours to several months. In a particularly preferred
embodiment the drug is released in effective concentrations for a
period ranging from 1 week-6 months. It should be readily evident
based upon the discussions provided herein that analogues and
derivatives of 5-fluorouracil (as described previously) with
similar functional activity can be utilized for the purposes of
this invention; the above dosing parameters are then adjusted
according to the relative potency of the analogue or derivative as
compared to the parent compound (e.g., a compound twice as potent
as 5-fluorouracil is administered at half the above parameters, a
compound half as potent as 5-fluorouracil is administered at twice
the above parameters, etc.).
[0489] (c) Podophylotoxins Utilizing the podophylotoxin etoposide
as an example, whether applied as a polymer coating, incorporated
into the polymers which make up the cardiac implant, or applied
without a carrier polymer, the total dose of etoposide applied
should not exceed 25 mg (range of 0.1 .mu.g to 25 mg). In a
particularly preferred embodiment, the total amount of drug applied
should be in the range of 1 .mu.g to 5 mg. The dose per unit area
(i.e., the amount of drug as a function of the surface area of the
portion of the implant to which drug is applied and/or
incorporated) should fall within the range of 0.01 .mu.g-100 .mu.g
per mm.sup.2 of surface area. In a particularly preferred
embodiment, etoposide should be applied to the implant surface at a
dose of 0.1 .mu.g/mm.sup.2-10 .mu.g/mm.sup.2. As different polymer
and non-polymer coatings will release etoposide at differing rates,
the above dosing parameters should be utilized in combination with
the release rate of the drug from the implant surface such that a
concentration of 10.sup.-4-10.sup.-7 M of etoposide is maintained.
It is necessary to insure that surface drug concentrations exceed
concentrations of etoposide known to be lethal to a variety of
bacteria and fungi (i.e., are in excess of 10.sup.-5 M; although
for some embodiments lower drug levels will be sufficient). In a
preferred embodiment, etoposide is released from the surface of the
implant such that anti-infective activity is maintained for a
period ranging from several hours to several months. In a
particularly preferred embodiment the drug is released in effective
concentrations for a period ranging from 1 week-6 months. It should
be readily evident based upon the discussions provided herein that
analogues and derivatives of etoposide (as described previously)
with similar functional activity can be utilized for the purposes
of this invention; the above dosing parameters are then adjusted
according to the relative potency of the analogue or derivative as
compared to the parent compound (e.g., a compound twice as potent
as etoposide is administered at half the above parameters, a
compound half as potent as etoposide is administered at twice the
above parameters, etc.).
[0490] It may be readily evident based upon the discussions
provided herein that combinations of anthracyclines (e.g.,
doxorubicin or mitoxantrone), fluoropyrimidines (e.g.,
5-fluorouracil), folic acid antagonists (e.g., methotrexate and/or
podophylotoxins (e.g., etoposide) can be utilized to enhance the
antibacterial activity of the composition.
[0491] In another aspect, an anti-infective agent (e.g.,
anthracyclines (e.g., doxorubicin or mitoxantrone),
fluoropyrimidines (e.g., 5-fluorouracil), folic acid antagonists
(e.g., methotrexate and/or podophylotoxins (e.g., etoposide)) can
be combined with traditional antibiotic and/or antifungal agents to
enhance efficacy. The anti-infective agent may be further combined
with anti-thrombotic and/or antiplatelet agents (for example,
heparin, dextran sulphate, danaparoid, lepirudin, hirudin, AMP,
adenosine, 2-chloroadenosine, aspirin, phenylbutazone,
indomethacin, meclofenamate, hydrochloroquine, dipyridamole,
iloprost, ticlopidine, clopidogrel, abcixamab, eptifibatide,
tirofiban, streptokinase, and/or tissue plasminogen activator) to
enhance efficacy.
[0492] In addition to incorporation of the above-mentioned
therapeutic agents (i.e., anti-infective agents or
fibrosis-inhibiting agents), one or more other pharmaceutically
active agents can be incorporated into the present compositions and
devices to improve or enhance efficacy. Representative examples of
additional therapeutically active agents include, by way of example
and not limitation, anti-thrombotic agents, anti-proliferative
agents, anti-inflammatory agents, neoplastic agents, enzymes,
receptor antagonists or agonists, hormones, antibiotics,
antimicrobial agents, antibodies, cytokine inhibitors, IMPDH
(inosine monophosplate dehydrogenase) inhibitors tyrosine kinase
inhibitors, MMP inhibitors, p38 MAP kinase inhibitors,
immunosuppressants, apoptosis antagonists, caspase inhibitors, and
JNK inhibitors.
[0493] Implantable electrical devices and compositions for use with
implantable electrical devices may further include an
anti-thrombotic agent and/or antiplatelet agent and/or a
thrombolytic agent, which reduces the likelihood of thrombotic
events upon implantation of a medical implant. Within various
embodiments of the invention, a device is coated on one aspect with
a composition which inhibits fibrosis (and/or restenosis), as well
as being coated with a composition or compound which prevents
thrombosis on another aspect of the device. Representative examples
of anti-thrombotic and/or antiplatelet and/or thrombolytic agents
include heparin, heparin fragments, organic salts of heparin,
heparin complexes (e.g., benzalkonium heparinate,
tridodecylammonium heparinate), dextran, sulfonated carbohydrates
such as dextran sulphate, coumadin, coumarin, heparinoid,
danaparoid, argatroban chitosan sulfate, chondroitin sulfate,
danaparoid, lepirudin, hirudin, AMP, adenosine, 2-chloroadenosine,
acetylsalicylic acid, phenylbutazone, indomethacin, meclofenamate,
hydrochloroquine, dipyridamole, iloprost, streptokinase, factor Xa
inhibitors, such as DX9065a, magnesium, and tissue plasminogen
activator. Further examples include plasminogen, lys-plasminogen,
alpha-2-antiplasmin, urokinase, aminocaproic acid, ticlopidine,
clopidogrel, trapidil (triazolopyrimidine), naftidrofuryl,
auriritricarboxylic acid and glycoprotein IIb/IIIa inhibitors such
as abcixamab, eptifibatide, and tirogiban. Other agents capable of
affecting the rate of clotting include glycosaminoglycans,
danaparoid, 4-hydroxycourmarin, warfarin sodium, dicumarol,
phenprocoumon, indan-1,3-dione, acenocoumarol, anisindione, and
rodenticides including bromadiolone, brodifacoum, diphenadione,
chlorophacinone, and pidnone.
[0494] Compositions for use with electrical devices may be or
include a hydrophilic polymer gel that itself has anti-thrombogenic
properties. For example, the composition can be in the form of a
coating that can comprise a hydrophilic, biodegradable polymer that
is physically removed from the surface of the device over time,
thus reducing adhesion of platelets to the device surface. The gel
composition can include a polymer or a blend of polymers.
Representative examples include alginates, chitosan and chitosan
sulfate, hyaluronic acid, dextran sulfate, PLURONIC polymers (e.g.,
F-127 or F87), chain extended PLURONIC polymers, various
polyester-polyether block copolymers of various configurations
(e.g., AB, ABA, or BAB, where A is a polyester such as PLA, PGA,
PLGA, PCL or the like), examples of which include MePEG-PLA,
PLA-PEG-PLA, and the like). In one embodiment, the anti-thrombotic
composition can include a crosslinked gel formed from a combination
of molecules (e.g., PEG) having two or more terminal electrophilic
groups and two or more nucleophilic groups.
[0495] Electrical devices and compositions for use with implantable
electrical devices may further include a compound which acts to
have an inhibitory effect on pathological processes in or around
the treatment site. In certain aspects, the agent may be selected
from one of the following classes of compounds: anti-inflammatory
agents (e.g., dexamethasone, cortisone, fludrocortisone,
prednisone, prednisolone, 6.alpha.-methylprednisolone,
triamcinolone, betamethasone, and aspirin); MMP inhibitors (e.g.,
batimistat, marimistat, TIMP's representative examples of which are
included in U.S. Pat. Nos. 5,665,777; 5,985,911; 6,288,261;
5,952,320; 6,441,189; 6,235,786; 6,294,573; 6,294,539; 6,563,002;
6,071,903; 6,358,980; 5,852,213; 6,124,502; 6,160,132; 6,197,791;
6,172,057; 6,288,086; 6,342,508; 6,228,869; 5,977,408; 5,929,097;
6,498,167; 6,534,491; 6,548,524; 5,962,481; 6,197,795; 6,162,814;
6,441,023; 6,444,704; 6,462,073; 6,162,821; 6,444,639; 6,262,080;
6,486,193; 6,329,550; 6,544,980; 6,352,976; 5,968,795; 5,789,434;
5,932,763; 6,500,847; 5,925,637; 6,225,314; 5,804,581; 5,863,915;
5,859,047; 5,861,428; 5,886,043; 6,288,063; 5,939,583; 6,166,082;
5,874,473; 5,886,022; 5,932,577; 5,854,277; 5,886,024; 6,495,565;
6,642,255; 6,495,548; 6,479,502; 5,696,082; 5,700,838; 6,444,639;
6,262,080; 6,486,193; 6,329,550; 6,544,980; 6,352,976; 5,968,795;
5,789,434; 5,932,763; 6,500,847; 5,925,637; 6,225,314; 5,804,581;
5,863,915; 5,859,047; 5,861,428; 5,886,043; 6,288,063; 5,939,583;
6,166,082; 5,874,473; 5,886,022; 5,932,577; 5,854,277; 5,886,024;
6,495,565; 6,642,255; 6,495,548; 6,479,502; 5,696,082; 5,700,838;
5,861,436; 5,691,382; 5,763,621; 5,866,717; 5,902,791; 5,962,529;
6,017,889; 6,022,873; 6,022,898; 6,103,739; 6,127,427; 6,258,851;
6,310,084; 6,358,987; 5,872,152; 5,917,090; 6,124,329; 6,329,373;
6,344,457; 5,698,706; 5,872,146; 5,853,623; 6,624,144; 6,462,042;
5,981,491; 5,955,435; 6,090,840; 6,114,372; 6,566,384; 5,994,293;
6,063,786; 6,469,020; 6,118,001; 6,187,924; 6,310,088; 5,994,312;
6,180,611; 6,110,896; 6,380,253; 5,455,262; 5,470,834; 6,147,114;
6,333,324; 6,489,324; 6,362,183; 6,372,758; 6,448,250; 6,492,367;
6,380,258; 6,583,299; 5,239,078; 5,892,112; 5,773,438; 5,696,147;
6,066,662; 6,600,057; 5,990,158; 5,731,293; 6,277,876; 6,521,606;
6,168,807; 6,506,414; 6,620,813; 5,684,152; 6,451,791; 6,476,027;
6,013,649; 6,503,892; 6,420,427; 6,300,514; 6,403,644; 6,177,466;
6,569,899; 5,594,006; 6,417,229; 5,861,510; 6,156,798; 6,387,931;
6,350,907; 6,090,852; 6,458,822; 6,509,337; 6,147,061; 6,114,568;
6,118,016; 5,804,593; 5,847,153; 5,859,061; 6,194,451; 6,482,827;
6,638,952; 5,677,282; 6,365,630; 6,130,254; 6,455,569; 6,057,369;
6,576,628; 6,110,924; 6,472,396; 6,548,667; 5,618,844; 6,495,578;
6,627,411; 5,514,716; 5,256,657; 5,773,428; 6,037,472; 6,579,890;
5,932,595; 6,013,792; 6,420,415; 5,532,265; 5,639,746; 5,672,598;
5,830,915; 6,630,516; 5,324,634; 6,277,061; 6,140,099; 6,455,570;
5,595,885; 6,093,398; 6,379,667; 5,641,636; 5,698,404; 6,448,058;
6,008,220; 6,265,432; 6,169,103; 6,133,304; 6,541,521; 6,624,196;
6,307,089; 6,239,288; 5,756,545; 6,020,366; 6,117,869; 6,294,674;
6,037,361; 6,399,612; 6,495,568; 6,624,177; 5,948,780; 6,620,835;
6,284,513; 5,977,141; 6,153,612; 6,297,247; 6,559,142; 6,555,535;
6,350,885; 5,627,206; 5,665,764; 5,958,972; 6,420,408; 6,492,422;
6,340,709; 6,022,948; 6,274,703; 6,294,694; 6,531,499; 6,465,508;
6,437,177; 6,376,665; 5,268,384; 5,183,900; 5,189,178; 6,511,993;
6,617,354; 6,331,563; 5,962,466; 5,861,427; 5,830,869; and
6,087,359), cytokine inhibitors (chlorpromazine, mycophenolic acid,
rapamycin, 1.alpha.-hydroxy vitamin D.sub.3), IMPDH (inosine
monophosplate dehydrogenase) inhibitors (e.g., mycophenolic acid,
ribaviran, aminothiadiazole, thiophenfurin, tiazofurin, viramidine)
(Representative examples are included in U.S. Pat. Nos. 5,536,747;
5,807,876; 5,932,600; 6,054,472; 6,128,582; 6,344,465; 6,395,763;
6,399,773; 6,420,403; 6,479,628; 6,498,178; 6,514,979; 6,518,291;
6,541,496; 6,596,747; 6,617,323; and 6,624,184, U.S. patent
application Nos. 2002/0040022A1, 2002/0052513A1, 2002/0055483A1,
2002/0068346A1, 2002/0111378A1, 2002/0111495A1, 2002/0123520A1,
2002/0143176A1, 2002/0147160A1, 2002/0161038A1, 2002/0173491A1,
2002/0183315A1, 2002/0193612A1, 2003/0027845A1, 2003/0068302A1,
2003/0105073A1, 2003/0130254A1, 2003/0143197A1, 2003/0144300A1,
2003/0166201A1, 2003/0181497A1, 2003/0186974A1, 2003/0186989A1, and
2003/0195202A1, and PCT Publication Nos. WO 00/24725A1, WO
00/25780A1, WO 00/26197A1, WO 00/51615A1, WO 00/56331A1, WO
00/73288A1, WO 01/00622A1, WO 01/66706A1, WO 01/79246A2, WO
01/81340A2, WO 01/85952A2, WO 02/16382A1, WO 02/18369A2, WO
02/051814A1, WO 02/057287A2, WO 02/057425A2, WO 02/060875A1, WO
02/060896A1, WO 02/060898A1, WO 02/068058A2, WO 03/020298A1, WO
03/037349A1, WO 03/039548A1, WO 03/045901A2, WO 03/047512A2, WO
03/053958A1, WO 03/055447A2, WO 03/059269A2, WO 03/063573A2, WO
03/087071 A1, WO 99/001545A1, WO 97/40028A1, WO 97/41211A1, WO
98/40381 A1, and WO 99/55663A1), p38 MAP kinase inhibitors (MAPK)
(e.g., GW-2286, CGP-52411, BIRB-798, SB220025, RO-320-1195,
RWJ-67657, RWJ-68354, SCIO-469) (Representative examples are
included in U.S. Pat. Nos. 6,300,347; 6,316,464; 6,316,466;
6,376,527; 6,444,696; 6,479,507; 6,509,361; 6,579,874, and
6,630,485, and U.S. patent application Publication Nos.
2001/0044538A1, 2002/0013354A1, 2002/0049220A1, 2002/0103245A1,
2002/0151491A1, 2002/0156114A1, 2003/0018051A1, 2003/0073832A1,
2003/0130257A1, 2003/0130273A1, 2003/0130319A1, 2003/0139388A1,
2003/0139462A1, 2003/0149031A1, 2003/0166647A1, and 2003/0181411A1,
and PCT Publication Nos. WO 00/63204A2, WO 01/21591A1, WO
01/35959A1, WO 01/74811A2, WO 02/18379A2, WO 02/064594A2, WO
02/083622A2, WO 02/094842A2,WO 02/096426A1, WO 02/101015A2, WO
02/103000A2, WO 03/008413A1, WO 03/016248A2, WO 03/020715A1, WO
03/024899A2, WO 03/031431A1, WO 03/040103A1, WO 03/053940A1, WO
03/053941A2, WO 03/063799A2, WO 03/079986A2, WO 03/080024A2, WO
03/082287A1, WO 97/44467A1, WO 99/01449A1, and WO 99/58523A1), and
immunomodulatory agents (rapamycin, everolimus, ABT-578,
azathioprine azithromycin, analogues of rapamycin, including
tacrolimus and derivatives thereof (e.g., EP 0184162B1 and those
described in U.S. Pat. No. 6,258,823) and everolimus and
derivatives thereof (e.g., U.S. Pat. No. 5,665,772). Further
representative examples of sirolimus analogues and derivatives
include ABT-578 and those found in PCT Publication Nos. WO
97/10502, WO 96/41807, WO 96/35423, WO 96/03430, WO 96/00282, WO
95/16691, WO 95/15328, WO 95/07468, WO 95/04738, WO 95/04060, WO
94/25022, WO 94/21644, WO 94/18207, WO 94/10843, WO 94/09010, WO
94/04540, WO 94/02485, WO 94/02137, WO 94/02136, WO 93/25533, WO
93/18043, WO 93/13663, WO 93/11130, WO 93/10122, WO 93/04680, WO
92/14737, and WO 92/05179 and in U.S. Pat. Nos. 6,342,507;
5,985,890; 5,604,234; 5,597,715; 5,583,139; 5,563,172; 5,561,228;
5,561,137; 5,541,193; 5,541,189; 5,534,632; 5,527,907; 5,484,799;
5,457,194; 5,457,182; 5,362,735; 5,324,644; 5,318,895; 5,310,903;
5,310,901; 5,258,389; 5,252,732; 5,247,076; 5,225,403; 5,221,625;
5,210,030; 5,208,241; 5,200,411; 5,198,421; 5,147,877; 5,140,018;
5,116,756; 5,109,112; 5,093,338; and 5,091,389.
[0496] Other examples of biologically active agents which may be
combined with implantable electrical devices according to the
invention include tyrosine kinase inhibitors, such as imantinib,
ZK-222584, CGP-52411, CGP-53716, NVP-AAK980-NX, CP-127374,
CP-564959, PD-171026, PD-173956, PD-180970, SU-0879, and SKI-606;
MMP inhibitors such as nimesulide, PKF-241-466, PKF-242-484,
CGS-27023A, SAR-943, primomastat, SC-77964, PNU-171829, AG-3433,
PNU-142769, SU-5402, and dexlipotam; p38 MAP kinase inhibitors such
as include CGH-2466 and PD-98-59; immunosuppressants such as
argyrin B, macrocyclic lactone, ADZ-62-826, CCI-779, tilomisole,
amcinonide, FK-778, AVE-1726, and MDL-28842; cytokine inhibitors
such as TNF-484A, PD-1 72084, CP-293121, CP-353164, and PD-168787;
NFKB inhibitors, such as, AVE-0547, AVE-0545, and IPL-576092;
HMGCoA reductase inhibitors, such as, pravestatin, atorvastatin,
fluvastatin, dalvastatin, glenvastatin, pitavastatin, CP-83101,
U-20685; apoptosis antagonist (e.g., troloxamine, TCH-346
(N-methyl-N-propargyl-10-aminomethyl-dibenzo(- b,f)oxepin); and
caspase inhibitors (e.g., PF-5901 (benzenemethanol,
alpha-pentyl-3-(2-quinolinylmethoxy)-), and JNK inhibitor (e.g.,
AS-602801).
[0497] In another aspect, the electrical device may further include
an antibiotic (e.g., amoxicillin, trimethoprim-sulfamethoxazole,
azithromycin, clarithromycin, amoxicillin-clavulanate, cefprozil,
cefuroxime, cefpodoxime, or cefdinir).
[0498] In certain aspects, a polymeric composition comprising a
fibrosis-inhibiting agent is combined with an agent that can modify
metabolism of the agent in vivo to enhance efficacy of the
fibrosis-inhibiting agent. One class of therapeutic agents that can
be used to alter drug metabolism includes agents capable of
inhibiting oxidation of the anti-scarring agent by cytochrome P450
(CYP). In one embodiment, compositions are provided that include a
fibrosis-inhibiting agent (e.g., paclitaxel, rapamycin, everolimus)
and a CYP inhibitor, which may be combined (e.g., coated) with any
of the devices described herein. Representative examples of CYP
inhibitors include flavones, azole antifungals, macrolide
antibiotics, HIV protease inhibitors, and anti-sense oligomers.
Devices comprising a combination of a fibrosis-inhibiting agent and
a CYP inhibitor may be used to treat a variety of proliferative
conditions that can lead to undesired scarring of tissue, including
intimal hyperplasia, surgical adhesions, and tumor growth.
[0499] Within various embodiments of the invention, a device
incorporates or is coated on one aspect, portion or surface with a
composition which inhibits fibrosis (and/or restenosis), as well as
with a composition or compound which promotes fibrosis on another
aspect, portion or surface of the device. Representative examples
of agents that promote fibrosis include silk and other irritants
(e.g., talc, wool (including animal wool, wood wool, and synthetic
wool), talcum powder, copper, metallic beryllium (or its oxides),
quartz dust, silica, crystalline silicates), polymers (e.g.,
polylysine, polyurethanes, poly(ethylene terephthalate), PTFE,
poly(alkylcyanoacrylates), and poly(ethylene-co-vinylacetate);
vinyl chloride and polymers of vinyl chloride; peptides with high
lysine content; growth factors and inflammatory cytokines involved
in angiogenesis, fibroblast migration, fibroblast proliferation,
ECM synthesis and tissue remodeling, such as epidermal growth
factor (EGF) family, transforming growth factor-.alpha.
(TGF-.alpha.), transforming growth factor-.beta. (TGF-.beta.-1,
TGF-.beta.-2, TGF-.beta.-3, platelet-derived growth factor (PDGF),
fibroblast growth factor (acidic-aFGF; and basic-bFGF), fibroblast
stimulating factor-1, activins, vascular endothelial growth factor
(including VEGF-2, VEGF-3, VEGF-A, VEGF-B, VEGF-C, placental growth
factor-PIGF), angiopoietins, insulin-like growth factors (IGF),
hepatocyte growth factor (HGF), connective tissue growth factor
(CTGF), myeloid colony-stimulating factors (CSFS), monocyte
chemotactic protein, granulocyte-macrophage colony-stimulating
factors (GM-CSF), granulocyte colony-stimulating factor (G-CSF),
macrophage colony-stimulating factor (M-CSF), erythropoietin,
interleukins (particularly IL-1, IL-8, and IL-6), tumor necrosis
factor-.alpha. (TNF.alpha.), nerve growth factor (NGF),
interferon-.alpha., interferon-.beta., histamine, endothelin-1,
angiotensin II, growth hormone (GH), and synthetic peptides,
analogues or derivatives of these factors are also suitable for
release from specific implants and devices to be described later.
Other examples include CTGF (connective tissue growth factor);
inflammatory microcrystals (e.g., crystalline minerals such as
crystalline silicates); bromocriptine, methylsergide, methotrexate,
chitosan, N-carboxybutyl chitosan, carbon tetrachloride,
thioacetamide, fibrosin, ethanol, bleomycin, naturally occurring or
synthetic peptides containing the Arg-Gly-Asp (RGD) sequence,
generally at one or both termini (see, e.g., U.S. Pat. No.
5,997,895), and tissue adhesives, such as cyanoacrylate and
crosslinked poly(ethylene glycol)-methylated collagen compositions.
Other examples of fibrosis-inducing agents include bone morphogenic
proteins (e.g., BMP-2, BMP-3, BMP-4, BMP-5, BMP-6 (Vgr-1), BMP-7
(OP-1), BMP-8, BMP-9, BMP-10, BMP-11, BMP-12, BMP-13, BMP-14,
BMP-15, and BMP-16. Of these, BMP-2, BMP-3, BMP-4, BMP-5, BMP-6,
and BMP-7 are of particular utility. Bone morphogenic proteins are
described, for example, in U.S. Pat. Nos. 4,877,864; 5,013,649;
5,661,007; 5,688,678; 6,177,406; 6,432,919; and 6,534,268 and
Wozney, J. M., et al. (1988) Science: 242(4885); 1528-1534.
[0500] Other representative examples of fibrosis-inducing agents
include components of extracellular matrix (e.g., fibronectin,
fibrin, fibrinogen, collagen (e.g., bovine collagen), including
fibrillar and non-fibrillar collagen, adhesive glycoproteins,
proteoglycans (e.g., heparin sulfate, chondroitin sulfate, dermatan
sulfate), hyaluronan, secreted protein acidic and rich in cysteine
(SPARC), thrombospondins, tenacin, and cell adhesion molecules
(including integrins, vitronectin, fibronectin, laminin, hyaluronic
acid, elastin, bitronectin), proteins found in basement membranes,
and fibrosin) and inhibitors of matrix metalloproteinases, such as
TIMPs (tissue inhibitors of matrix metalloproteinases) and
synthetic TIMPs, such as, e.g., marimistat, batimistat,
doxycycline, tetracycline, minocycline, TROCADE, Ro-1130830, CGS
27023A, and BMS-275291 and analogues and derivatives thereof.
[0501] Although the above therapeutic agents have been provided for
the purposes of illustration, it may be understood that the present
invention is not so limited. For example, although agents are
specifically referred to above, the present invention may be
understood to include analogues, derivatives and conjugates of such
agents. As an illustration, paclitaxel may be understood to refer
to not only the common chemically available form of paclitaxel, but
analogues (e.g., TAXOTERE, as noted above) and paclitaxel
conjugates (e.g., paclitaxel-PEG, paclitaxel-dextran, or
paclitaxel-xylos). In addition, as will be evident to one of skill
in the art, although the agents set forth above may be noted within
the context of one class, many of the agents listed in fact have
multiple biological activities. Further, more than one therapeutic
agent may be utilized at a time (i.e., in combination), or
delivered sequentially.
[0502] C. Dosages Since neurostimulation devices and cardiac rhythm
management devices are made in a variety of configurations and
sizes, the exact dose administered may vary with device size,
surface area and design. However, certain principles can be applied
in the application of this art. Drug dose can be calculated as a
function of dose (i.e., amount) per unit area of the portion of the
device being coated. Surface area can be measured or determined by
methods known to one of ordinary skill in the art. Total drug dose
administered can be measured and appropriate surface concentrations
of active drug can be determined. Drugs are to be used at
concentrations that range from several times more than to 10%, 5%,
or even less than 1% of the concentration typically used in a
single chemotherapeutic systemic dose application. In certain
aspects, the drug is released in effective concentrations for a
period ranging from 1-90 days. Regardless of the method of
application of the drug to the device, the fibrosis-inhibiting
agents, used alone or in combination, should be administered under
the following dosing guidelines:
[0503] As described above, electrical devices may be used in
combination with a composition that includes an anti-scarring
agent. The total amount (dose) of anti-scarring agent in or on the
device may be in the range of about 0.01 .mu.g-10 .mu.g, or 10
.mu.g-10 mg, or 10 mg-250 mg, or 250 mg-1000 mg, or 1000 mg-2500
mg. The dose (amount) of anti-scarring agent per unit area of
device surface to which the agent is applied may be in the range of
about 0.01 .mu.g/mm.sup.2-1 .mu.g/mm.sup.2, or 1 .mu.g/mm.sup.2-10
.mu.g/mm.sup.2, or 10 .mu.g/mm.sup.2-250 .mu.g/mm.sup.2, 250
.mu.g/mm.sup.2 -1000 .mu.g/mm.sup.2, or 1000 .mu.g/mm.sup.2-2500
.mu.g/mm.sup.2.
[0504] It should be apparent to one of skill in the art that
potentially any anti-scarring agent described above may be utilized
alone, or in combination, in the practice of this embodiment.
[0505] In various aspects, the present invention provides a medical
device contain an angiogenesis inhibitor in a dosage as set forth
above. In various aspects, the present invention provides a medical
device containing a 5-lipoxygenase inhibitor or antagonist in a
dosage as set forth above. In various aspects, the present
invention provides a medical device containing a chemokine receptor
antagonist in a dosage as set forth above. In various aspects, the
present invention provides a medical device containing a cell cycle
inhibitor in a dosage as set forth above. In various aspects, the
present invention provides a medical device containing an
anthracycline (e.g., doxorubicin and mitoxantrone) in a dosage as
set forth above. In various aspects, the present invention provides
a medical device containing a taxane (e.g., paclitaxel or an
analogue or derivative of paclitaxel) in a dosage as set forth
above. In various aspects, the present invention provides a medical
device containing a podophyllotoxin (e.g., etoposide) in a dosage
as set forth above. In various aspects, the present invention
provides a medical device containing a vinca alkaloid in a dosage
as set forth above. In various aspects, the present invention
provides a medical device containing a camptothecin or an analogue
or derivative thereof in a dosage as set forth above. In various
aspects, the present invention provides a medical device containing
a platinum compound in a dosage as set forth above. In various
aspects, the present invention provides a medical device containing
a nitrosourea in a dosage as set forth above. In various aspects,
the present invention provides a medical device containing a
nitroimidazole in a dosage as set forth above. In various aspects,
the present invention provides a medical device containing a folic
acid antagonist in a dosage as set forth above. In various aspects,
the present invention provides a medical device containing a
cytidine analogue in a dosage as set forth above. In various
aspects, the present invention provides a medical device containing
a pyrimidine analogue in a dosage as set forth above. In various
aspects, the present invention provides a medical device containing
a fluoropyrimidine analogue in a dosage as set forth above. In
various aspects, the present invention provides a medical device
containing a purine analogue in a dosage as set forth above. In
various aspects, the present invention provides a medical device
containing a nitrogen mustard in a dosage as set forth above. In
various aspects, the present invention provides a medical device
containing a hydroxyurea in a dosage as set forth above. In various
aspects, the present invention provides a medical device containing
a mytomicin in a dosage as set forth above. In various aspects, the
present invention provides a medical device containing an alkyl
sulfonate in a dosage as set forth above. In various aspects, the
present invention provides a medical device containing a benzamide
in a dosage as set forth above. In various aspects, the present
invention provides a medical device containing a nicotinamide in a
dosage as set forth above. In various aspects, the present
invention provides a medical device containing a halogenated sugar
in a dosage as set forth above. In various aspects, the present
invention provides a medical device containing a DNA alkylating
agent in a dosage as set forth above. In various aspects, the
present invention provides a medical device containing an
anti-microtubule agent in a dosage as set forth above. In various
aspects, the present invention provides a medical device containing
a topoisomerase inhibitor in a dosage as set forth above. In
various aspects, the present invention provides a medical device
containing a DNA cleaving agent in a dosage as set forth above. In
various aspects, the present invention provides a medical device
containing an antimetabolite in a dosage as set forth above. In
various aspects, the present invention provides a medical device
containing an agent that inhibits adenosine deaminase in a dosage
as set forth above. In various aspects, the present invention
provides a medical device containing an agent that inhibits purine
ring synthesis in a dosage as set forth above. In various aspects,
the present invention provides a medical device containing a
nucleotide interconversion inhibitor in a dosage as set forth
above. In various aspects, the present invention provides a medical
device containing an agent that inhibits dihydrofolate reduction in
a dosage as set forth above. In various aspects, the present
invention provides a medical device containing an agent that blocks
thymidine monophosphate function in a dosage as set forth above. In
various aspects, the present invention provides a medical device
containing an agent that causes DNA damage in a dosage as set forth
above. In various aspects, the present invention provides a medical
device containing a DNA intercalation agent in a dosage as set
forth above. In various aspects, the present invention provides a
medical device containing an agent that is a RNA synthesis
inhibitor in a dosage as set forth above. In various aspects, the
present invention provides a medical device containing an agent
that is a pyrimidine synthesis inhibitor in a dosage as set forth
above. In various aspects, the present invention provides a medical
device containing an agent that inhibits ribonucleotide synthesis
in a dosage as set forth above. In various aspects, the present
invention provides a medical device containing an agent that
inhibits thymidine monophosphate synthesis in a dosage as set forth
above. In various aspects, the present invention provides a medical
device containing an agent that inhibits DNA synthesis in a dosage
as set forth above. In various aspects, the present invention
provides a medical device containing an agent that causes DNA
adduct formation in a dosage as set forth above. In various
aspects, the present invention provides a medical device containing
an agent that inhibits protein synthesis in a dosage as set forth
above. In various aspects, the present invention provides a medical
device containing an agent that inhibits microtubule function in a
dosage as set forth above. In various aspects, the present
invention provides a medical device containing an immunomodulatory
agent (e.g., sirolimus, everolimus, tacrolimus, or an analogue or
derivative thereof) in a dosage as set forth above. In various
aspects, the present invention provides a medical device containing
a heat shock protein 90 antagonist (e.g., geldanamycin) in a dosage
as set forth above. In various aspects, the present invention
provides a medical device containing an HMGCoA reductase inhibitor
(e.g., simvastatin) in a dosage as set forth above. In various
aspects, the present invention provides a medical device containing
an inosine monophosphate dehydrogenase inhibitor (e.g.,
mycophenolic acid, 1-alpha-25 dihydroxy vitamin D.sub.3) in a
dosage as set forth above. In various aspects, the present
invention provides a medical device containing an NF kappa B
inhibitor (e.g., Bay 11-7082) in a dosage as set forth above. In
various aspects, the present invention provides a medical device
containing an antimycotic agent (e.g., sulconizole) in a dosage as
set forth above. In various aspects, the present invention provides
a medical device containing a p38 MAP Kinase inhibitor (e.g.,
SB202190) in a dosage as set forth above. In various aspects, the
present invention provides a medical device containing a cyclin
dependent protein kinase inhibitor in a dosage as set forth above.
In various aspects, the present invention provides a medical device
containing an epidermal growth factor kinase inhibitor in a dosage
as set forth above. In various aspects, the present invention
provides a medical device containing an elastase inhibitor in a
dosage as set forth above. In various aspects, the present
invention provides a medical device containing a factor Xa
inhibitor in a dosage as set forth above. In various aspects, the
present invention provides a medical device containing a
farnesyltransferase inhibitor in a dosage as set forth above. In
various aspects, the present invention provides a medical device
containing a fibrinogen antagonist in a dosage as set forth above.
In various aspects, the present invention provides a medical device
containing a guanylate cyclase stimulant in a dosage as set forth
above. In various aspects, the present invention provides a medical
device containing a hydroorotate dehydrogenase inhibitor in a
dosage as set forth above. In various aspects, the present
invention provides a medical device containing an IKK2 inhibitor in
a dosage as set forth above. In various aspects, the present
invention provides a medical device containing an IL-1 antagonist
in a dosage as set forth above. In various aspects, the present
invention provides a medical device containing an ICE antagonist in
a dosage as set forth above. In various aspects, the present
invention provides a medical device containing an IRAK antagonist
in a dosage as set forth above. In various aspects, the present
invention provides a medical device containing an IL-4 agonist in a
dosage as set forth above. In various aspects, the present
invention provides a medical device containing a leukotriene
inhibitor in a dosage as set forth above. In various aspects, the
present invention provides a medical device containing an MCP-1
antagonist in a dosage as set forth above. In various aspects, the
present invention provides a medical device containing a MMP
inhibitor in a dosage as set forth above. In various aspects, the
present invention provides a medical device containing an NO
antagonist in a dosage as set forth above. In various aspects, the
present invention provides a medical device containing a
phosphodiesterase inhibitor in a dosage as set forth above. In
various aspects, the present invention provides a medical device
containing a TGF beta inhibitor in a dosage as set forth above. In
various aspects, the present invention provides a medical device
containing a thromboxane A2 antagonist in a dosage as set forth
above. In various aspects, the present invention provides a medical
device containing a TNF.alpha. antagonist in a dosage as set forth
above. In various aspects, the present invention provides a medical
device containing a TACE inhibitor in a dosage as set forth above.
In various aspects, the present invention provides a medical device
containing a tyrosine kinase inhibitor in a dosage as set forth
above. In various aspects, the present invention provides a medical
device containing a vitronectin inhibitor in a dosage as set forth
above. In various aspects, the present invention provides a medical
device containing a fibroblast growth factor inhibitor in a dosage
as set forth above. In various aspects, the present invention
provides a medical device containing a protein kinase inhibitor in
a dosage as set forth above. In various aspects, the present
invention provides a medical device containing a PDGF receptor
kinase inhibitor in a dosage as set forth above. In various
aspects, the present invention provides a medical device containing
an endothelial growth factor receptor kinase inhibitor in a dosage
as set forth above. In various aspects, the present invention
provides a medical device containing a retinoic acid receptor
antagonist in a dosage as set forth above. In various aspects, the
present invention provides a medical device containing a platelet
derived growth factor receptor kinase inhibitor in a dosage as set
forth above. In various aspects, the present invention provides a
medical device containing a fibrinogen antagonist in a dosage as
set forth above. In various aspects, the present invention provides
a medical device containing a bisphosphonate in a dosage as set
forth above. In various aspects, the present invention provides a
medical device containing a phospholipase A1 inhibitor in a dosage
as set forth above. In various aspects, the present invention
provides a medical device containing a histamine H1/H2/H3 receptor
antagonist in a dosage as set forth above. In various aspects, the
present invention provides a medical device containing a macrolide
antibiotic in a dosage as set forth above. In various aspects, the
present invention provides a medical device containing a GPIIb IIa
receptor antagonist in a dosage as set forth above. In various
aspects, the present invention provides a medical device containing
an endothelin receptor antagonist in a dosage as set forth above.
In various aspects, the present invention provides a medical device
containing a peroxisome proliferator-activated receptor agonist in
a dosage as set forth above. In various aspects, the present
invention provides a medical device containing an estrogen receptor
agent in a dosage as set forth above. In various aspects, the
present invention provides a medical device containing a
somastostatin analogue in a dosage as set forth above. In various
aspects, the present invention provides a medical device containing
a neurokinin 1 antagonist in a dosage as set forth above. In
various aspects, the present invention provides a medical device
containing a neurokinin 3 antagonist in a dosage as set forth
above. In various aspects, the present invention provides a medical
device containing a VLA-4 antagonist in a dosage as set forth
above. In various aspects, the present invention provides a medical
device containing an osteoclast inhibitor in a dosage as set forth
above. In various aspects, the present invention provides a medical
device containing a DNA topoisomerase ATP hydrolyzing inhibitor in
a dosage as set forth above. In various aspects, the present
invention provides a medical device containing an angiotensin I
converting enzyme inhibitor in a dosage as set forth above. In
various aspects, the present invention provides a medical device
containing an angiotensin II antagonist in a dosage as set forth
above. In various aspects, the present invention provides a medical
device containing an enkephalinase inhibitor in a dosage as set
forth above. In various aspects, the present invention provides a
medical device containing a peroxisome proliferator-activated
receptor gamma agonist insulin sensitizer in a dosage as set forth
above. In various aspects, the present invention provides a medical
device containing a protein kinase C inhibitor in a dosage as set
forth above. In various aspects, the present invention provides a
medical device containing a ROCK (rho-associated kinase) inhibitor
in a dosage as set forth above. In various aspects, the present
invention provides a medical device containing a CXCR3 inhibitor in
a dosage as set forth above. In various aspects, the present
invention provides a medical device containing a Itk inhibitor in a
dosage as set forth above. In various aspects, the present
invention provides a medical device containing a cytosolic
phospholipase A.sub.2-alpha inhibitor in a dosage as set forth
above. In various aspects, the present invention provides a medical
device containing a PPAR agonist in a dosage as set forth above. In
various aspects, the present invention provides a medical device
containing an Immunosuppressant in a dosage as set forth above. In
various aspects, the present invention provides a medical device
containing an Erb inhibitor in a dosage as set forth above. In
various aspects, the present invention provides a medical device
containing an apoptosis agonist in a dosage as set forth above. In
various aspects, the present invention provides a medical device
containing a lipocortin agonist in a dosage as set forth above. In
various aspects, the present invention provides a medical device
containing a VCAM-1 antagonist in a dosage as set forth above. In
various aspects, the present invention provides a medical device
containing a collagen antagonist in a dosage as set forth above. In
various aspects, the present invention provides a medical device
containing an alpha 2 integrin antagonist in a dosage as set forth
above. In various aspects, the present invention provides a medical
device containing a TNF alpha inhibitor in a dosage as set forth
above. In various aspects, the present invention provides a medical
device containing a nitric oxide inhibitor in a dosage as set forth
above. In various aspects, the present invention provides a medical
device containing a cathepsin inhibitor in a dosage as set forth
above.
[0506] Provided below are exemplary dosage ranges for a variety of
anti-scarring agents which can be used in conjunction with
electrical devices in accordance with the invention. A) Cell cycle
inhibitors including doxorubicin and mitoxantrone. Doxorubicin
analogues and derivatives thereof: total dose not to exceed 25 mg
(range of 0.1 .mu.g to 25 mg); preferred 1 .mu.g to 5 mg. The dose
per unit area of 0.01 .mu.g -100 .mu.g per mm.sup.2; preferred dose
of 0.1 .mu.g/mm.sup.2-10 .mu.g/mm.sup.2. Minimum concentration of
10.sup.-8-10.sup.-4 M of doxorubicin is to be maintained on the
device surface. Mitoxantrone and analogues and derivatives thereof:
total dose not to exceed 5 mg (range of 0.01 .mu.g to 5 mg);
preferred 0.1 .mu.g to 3 mg. The dose per unit area of the device
of 0.01 .mu.g-20 .mu.g per mm.sup.2; preferred dose of 0.05
.mu.g/mm.sup.2-5 .mu.g/mm.sup.2. Minimum concentration of
10.sup.-8-10.sup.-4 M of mitoxantrone is to be maintained on the
device surface. B) Cell cycle inhibitors including paclitaxel and
analogues and derivatives (e.g., docetaxel) thereof: total dose not
to exceed 10 mg (range of 0.1 .mu.g to 10 mg); preferred 1 .mu.g to
3 mg. The dose per unit area of the device of 0.1 .mu.g-10 .mu.g
per mm.sup.2; preferred dose of 0.25 .mu.g/mm.sup.2-5
.mu.g/mm.sup.2. Minimum concentration of 10.sup.-8-10.sup.-4 M of
paclitaxel is to be maintained on the device surface. (C) Cell
cycle inhibitors such as podophyllotoxins (e.g., etoposide): total
dose not to exceed 25 mg (range of 0.1 .mu.g to 25 mg); preferred 1
.mu.g to 5 mg. The dose per unit area of the device of 0.01
.mu.g-100 .mu.g per mm.sup.2; preferred dose of 0.1
.mu.g/mm.sup.2-10 .mu.g/mm.sup.2. Minimum concentration of
10.sup.-8-10.sup.-4 M of etoposide is to be maintained on the
device surface. (D) Immunomodulators including sirolimus and
everolimus. Sirolimus (i.e., Rapamycin, RAPAMUNE): Total dose not
to exceed 10 mg (range of 0.1 .mu.g to 10 mg); preferred 10 .mu.g
to 1 mg. The dose per unit area of 0.1 .mu.g-100 .mu.g per
mm.sup.2; preferred dose of 0.5 .mu.g/mm.sup.2-10 .mu.g/mm.sup.2.
Minimum concentration of 10.sup.-8-10.sup.-4 M is to be maintained
on the device surface. Everolimus and derivatives and analogues
thereof: Total dose should not exceed 10 mg (range of 0.1 .mu.g to
10 mg); preferred 10 .mu.g to 1 mg. The dose per unit area of 0.1
.mu.g-100 .mu.g per mm.sup.2 of surface area; preferred dose of 0.3
.mu.g/mm.sup.2-10 .mu.g/mm.sup.2. Minimum concentration of
10.sup.-8-10.sup.-4 M of everolimus is to be maintained on the
device surface. (E) Heat shock protein 90 antagonists (e.g.,
geldanamycin) and analogues and derivatives thereof: total dose not
to exceed 20 mg (range of 0.1 .mu.g to 20 mg); preferred 1 .mu.g to
5 mg. The dose per unit area of the device of 0.1 .mu.g-10 .mu.g
per mm.sup.2; preferred dose of 0.25 .mu.g/mm.sup.2-5
.mu.g/mm.sup.2. Minimum concentration of 10.sup.-8-10.sup.-4 M of
paclitaxel is to be maintained on the device surface. (F) HMGCoA
reductase inhibitors (e.g., simvastatin) and analogues and
derivatives thereof: total dose not to exceed 2000 mg (range of
10.0 .mu.g to 2000 mg); preferred 10 .mu.g to 300 mg. The dose per
unit area of the device of 1.0 .mu.g-1000 .mu.g per mm.sup.2;
preferred dose of 2.5 .mu.g/mm.sup.2-500 .mu.g/mm.sup.2. Minimum
concentration of 10.sup.-8-10.sup.-3 M of simvastatin is to be
maintained on the device surface. (G) Inosine monophosphate
dehydrogenase inhibitors (e.g., mycophenolic acid, 1-alpha-25
dihydroxy vitamin D.sub.3) and analogues and derivatives thereof:
total dose not to exceed 2000 mg (range of 10.0 .mu.g to 2000 mg);
preferred 10 .mu.g to 300 mg. The dose per unit area of the device
of 1.0 .mu.g-1000 .mu.g per mm.sup.2; preferred dose of 2.5
.mu.g/mm.sup.2-500 .mu.g/mm.sup.2. Minimum concentration of
10.sup.-8-10.sup.-3 M of mycophenolic acid is to be maintained on
the device surface. (H) NF kappa B inhibitors (e.g., Bay 11-7082)
and analogues and derivatives thereof: total dose not to exceed 200
mg (range of 1.0 .mu.g to 200 mg); preferred 1 .mu.g to 50 mg. The
dose per unit area of the device of 1.0 .mu.g-100 .mu.g per
mm.sup.2; preferred dose of 2.5 .mu.g/mm.sup.2-50 .mu.g/mm.sup.2.
Minimum concentration of 10.sup.-8-10.sup.-4 M of Bay 11-7082 is to
be maintained on the device surface. (I) Antimycotic agents (e.g.,
sulconizole) and analogues and derivatives thereof: total dose not
to exceed 2000 mg (range of 10.0 .mu.g to 2000 mg); preferred 10
.mu.g to 300 mg. The dose per unit area of the device of 1.0
.mu.g-1000 .mu.g per mm.sup.2; preferred dose of 2.5
.mu.g/mm.sup.2-500 .mu.g/mm.sup.2. Minimum concentration of
10.sup.-8-10.sup.-3 M of sulconizole is to be maintained on the
device surface. (J) p38 MAP kinase inhibitors (e.g., SB202190) and
analogues and derivatives thereof: total dose not to exceed 2000 mg
(range of 10.0 .mu.g to 2000 mg); preferred 10 .mu.g to 300 mg. The
dose per unit area of the device of 1.0 .mu.g-1000 .mu.g per
mm.sup.2; preferred dose of 2.5 .mu.g/mm.sup.2-500 .mu.g/mm.sup.2.
Minimum concentration of 10.sup.-8-10.sup.-3 M of SB202190 is to be
maintained on the device surface. (K) Anti-angiogenic agents (e.g.,
halofuginone bromide and analogues and derivatives thereof): total
dose not to exceed 10 mg (range of 0.1 .mu.g to 10 mg); preferred 1
.mu.g to 3 mg. The dose per unit area of the device of 0.1 .mu.g-10
.mu.g per mm.sup.2; preferred dose of 0.20 .mu.g/mm.sup.2 -5
.mu.g/mm.sup.2. Minimum concentration of 10.sup.-8-10.sup.-4 M of
halofuginone bromide is to be maintained on the device surface.
[0507] In addition to those described above (e.g., sirolimus,
everolimus, and tacrolimus), several other examples of
immunomodulators and appropriate dosage ranges for use with
neurostimulation and CR M devices include the following: (A)
Biolimus and derivatives and analogues thereof: Total dose should
not exceed 10 mg (range of 0.1 .mu.g to 10 mg); preferred 10 .mu.g
to 1 mg. The dose per unit area of 0.1 .mu.g-100 .mu.g per mm.sup.2
of surface area; preferred dose of 0.3 .mu.g/mm.sup.2-10
.mu.g/mm.sup.2. Minimum concentration of 10.sup.-8-10.sup.-4 M of
everolimus is to be maintained on the device surface. (B)
Tresperimus and derivatives and analogues thereof: Total dose
should not exceed 10 mg (range of 0.1 .mu.g to 10 mg); preferred 10
.mu.g to 1 mg. The dose per unit area of 0.1 .mu.g-100 .mu.g per
mm.sup.2 of surface area; preferred dose of 0.3 .mu.g/mm.sup.2-10
.mu.g/mm.sup.2. Minimum concentration of 10.sup.-8-10.sup.-4 M of
tresperimus is to be maintained on the device surface. (C)
Auranofin and derivatives and analogues thereof: Total dose should
not exceed 10 mg (range of 0.1 .mu.g to 10 mg); preferred 10 .mu.g
to 1 mg. The dose per unit area of 0.1 .mu.g-100 .mu.g per mm.sup.2
of surface area; preferred dose of 0.3 .mu.g/mm.sup.2-10
.mu.g/mm.sup.2. Minimum concentration of 10.sup.-8-10.sup.-4 M of
auranofin is to be maintained on the device surface. (D)
27-0-Demethylrapamycin and derivatives and analogues thereof: Total
dose should not exceed 10 mg (range of 0.1 .mu.g to 10 mg);
preferred 10 .mu.g to 1 mg. The dose per unit area of 0.1 .mu.g-100
.mu.g per mm.sup.2 of surface area; preferred dose of 0.3
.mu.g/mm.sup.2-10 .mu.g/mm.sup.2. Minimum concentration of
10.sup.-8-10.sup.-4 M of 27-0-Demethylrapamycin is to be maintained
on the device surface. (E) Gusperimus and derivatives and analogues
thereof: Total dose should not exceed 10 mg (range of 0.1 .mu.g to
10 mg); preferred 10 .mu.g to 1 mg. The dose per unit area of 0.1
.mu.g-100 .mu.g per mm.sup.2 of surface area; preferred dose of 0.3
.mu.g/mm.sup.2-10 .mu.g/mm.sup.2. Minimum concentration of
10.sup.-8-10.sup.-4 M of gusperimus is to be maintained on the
device surface. (F) Pimecrolimus and derivatives and analogues
thereof: Total dose should not exceed 10 mg (range of 0.1 .mu.g to
10 mg); preferred 10 .mu.g to 1 mg. The dose per unit area of 0.1
.mu.g-100 .mu.g per mm.sup.2 of surface area; preferred dose of 0.3
.mu.g/mm.sup.2-10 .mu.g/mm.sup.2. Minimum concentration of
10.sup.-8-10.sup.-4 M of pimecrolimus is to be maintained on the
device surface and (G) ABT-578 and analogues and derivatives
thereof: Total dose should not exceed 10 mg (range of 0.1 .mu.g to
10 mg); preferred 10 .mu.g to 1 mg. The dose per unit area of 0.1
.mu.g-100 .mu.g per mm.sup.2 of surface area; preferred dose of 0.3
.mu.g/mm.sup.2-10 .mu.g/mm.sup.2. Minimum concentration of
10.sup.-8-10.sup.-4 M of ABT-578 is to be maintained on the device
surface.
[0508] In addition to those described above (e.g., paclitaxel,
TAXOTERE, and docetaxel), several other examples of
anti-microtubule agents and appropriate dosage ranges for use with
ear ventilation devices include vinca alkaloids such as vinblastine
and vincristine sulfate and analogues and derivatives thereof:
total dose not to exceed 10 mg (range of 0.1 .mu.g to 10 mg);
preferred 1 .mu.g to 3 mg. Dose per unit area of the device of 0.1
.mu.g-10 .mu.g per mm.sup.2; preferred dose of 0.25
.mu.g/mm.sup.2-5 .mu.g/mm.sup.2. Minimum concentration of
10.sup.-8-10.sup.-4 M of drug is to be maintained on the device
surface.
[0509] D. Methods for Generating Medical Devices and Implants Which
Release a Fibrosis-Inhibitinq (or Gliosis-Inhibiting) Agent
[0510] In the practice of this invention, drug-coated or
drug-impregnated implants and medical devices are provided which
inhibit fibrosis (or gliosis) in and around the device, lead and/or
electrode of neurostimulation or cardiac rhythm management (CRM)
devices. Within various embodiments, fibrosis (or gliosis) is
inhibited by local, regional or systemic release of specific
pharmacological agents that become localized to the tissue adjacent
to the device or implant. There are numerous neurostimulation and
CR M devices where the occurrence of a fibrotic (or gliotic)
reaction may adversely affect the functioning of the device or the
biological problem for which the device was implanted or used.
Typically, fibrotic (or gliotic) encapsulation of the electrical
lead (or the growth of fibrous/glial tissue between the lead and
the target nerve tissue) slows, impairs, or interrupts electrical
transmission of the impulse from the device to the tissue. This can
cause the device to function suboptimally or not at all, or can
cause excessive drain on battery life as increased energy is
required to overcome the electrical resistance imposed by the
intervening scar (or glial) tissue. There are numerous methods
available for optimizing delivery of the fibrosis-inhibiting (or
gliosis-inhibiting) agent to the site of the intervention and
several of these are described below.
[0511] 1) Devices and Implants that Release Fibrosis-Inhibiting
Agents
[0512] Medical devices or implants of the present invention are
coated with, or otherwise adapted to release an agent which
inhibits fibrosis (or gliosis) on the surface of, or around, the
neurostimulator or CR M device, lead and/or electrode. In one
aspect, the present invention provides electrical devices that
include an anti-scarring (or anti-gliotic) agent or a composition
that includes an anti-scarring (or anti-gliotic) agent such that
the overgrowth of granulation (or gliotic) tissue is inhibited or
reduced.
[0513] Methods for incorporating fibrosis-inhibiting (or
gliosis-inhibiting) compositions onto or into CR M or
neurostimulator devices include: (a) directly affixing to the
device, lead and/or the electrode a fibrosis-inhibiting (or
gliosis-inhibiting) composition (e.g., by either a spraying process
or dipping process as described above, with or without a carrier),
(b) directly incorporating into the device, lead and/or the
electrode a fibrosis-inhibiting (or gliosis-inhibiting) composition
(e.g., by either a spraying process or dipping process as described
above, with or without a carrier (c) by coating the device, lead
and/or the electrode with a substance such as a hydrogel which may
in turn absorb the fibrosis-inhibiting (or gliosis-inhibiting)
composition, (d) by interweaving fibrosis-inhibiting (or
gliosis-inhibiting) composition coated thread (or the polymer
itself formed into a thread) into the device, lead and/or electrode
structure, (e) by inserting the device, lead and/or the electrode
into a sleeve or mesh which is comprised of, or coated with, a
fibrosis-inhibiting (or gliosis-inhibiting) composition, (f)
constructing the device, lead and/or the electrode itself (or a
portion of the device and/or the electrode) with a
fibrosis-inhibiting (or gliosis-inhibiting) composition, or (g) by
covalently binding the fibrosis-inhibiting (or gliosis-inhibiting)
agent directly to the device, lead and/or electrode surface or to a
linker (small molecule or polymer) that is coated or attached to
the device surface. For these devices, leads and electrodes, the
coating process can be performed in such a manner as to: (a) coat
the non-electrode portions of the lead or device; (b) coat the
electrode portion of the lead; (c) coat the sensor part of the
lead; or (d) coat all or parts of the entire device with the
fibrosis-inhibiting (or gliosis-inhibiting) composition. In
addition to, or alternatively, the fibrosis-inhibiting (or
gliosis-inhibiting) agent can be mixed with the materials that are
used to make the device, lead and/or electrode such that the
fibrosis-inhibiting agent is incorporated into the final
product.
[0514] In addition to, or as an alternative to incorporating a
fibrosis-inhibiting (or gliosis-inhibiting) agent onto or into the
CRM or neurostimulation device, the fibrosis-inhibiting (or
gliosis-inhibiting) agent can be applied directly or indirectly to
the tissue adjacent to the CRM or neurostimulator device
(preferably near the electrode-tissue interface). This can be
accomplished by applying the fibrosis-inhibiting (or gliosis
inhibiting) agent, with or without a polymeric, non-polymeric, or
secondary carrier: (a) to the lead and/or electrode surface (e.g.,
as an injectable, paste, gel or mesh) during the implantation
procedure); (b) to the surface of the tissue (e.g., as an
injectable, paste, gel, in situ forming gel or mesh) prior to,
immediately prior to, or during, implantation of the CRM or
neurostimulation device, lead and/or electrode; (c) to the surface
of the lead and/or electrode and/or the tissue surrounding the
implanted lead and/or electrode (e.g., as an injectable, paste,
gel, in situ forming gel or mesh) immediately after to the
implantation of the CRM or neurostimulation device, lead and/or
electrode; (d) by topical application of the anti-fibrosis (or
gliosis) agent into the anatomical space where the CRM or
neurostimulation device, lead and/or electrode may be placed
(particularly useful for this embodiment is the use of polymeric
carriers which release the fibrosis-inhibiting agent over a period
ranging from several hours to several weeks--fluids, suspensions,
emulsions, microemulsions, microspheres, pastes, gels,
microparticulates, sprays, aerosols, solid implants and other
formulations which release the agent can be delivered into the
region where the device may be inserted); (e) via percutaneous
injection into the tissue surrounding the device, lead and/or
electrode as a solution as an infusate or as a sustained release
preparation; (f) by any combination of the aforementioned methods.
Combination therapies (i.e., combinations of therapeutic agents and
combinations with antithrombotic and/or antiplatelet agents) can
also be used.
[0515] 2) Systemic, Regional and Local Delivery of
Fibrosis-Inhibiting (or Gliosis-Inhibiting) Agents
[0516] A variety of drug-delivery technologies are available for
systemic, regional and local delivery of therapeutic agents.
Several of these techniques may be suitable to achieve
preferentially elevated levels of fibrosis-inhibiting (or
gliosis-inhibiting) agents in the vicinity of the CRM or
neurostimulation device, lead and/or electrode, including: (a)
using drug-delivery catheters for local, regional or systemic
delivery of fibrosis-inhibiting (or gliosis-inhibiting) agents to
the tissue surrounding the device or implant. Typically, drug
delivery catheters are advanced through the circulation or inserted
directly into tissues under radiological guidance until they reach
the desired anatomical location. The fibrosis inhibiting agent can
then be released from the catheter lumen in high local
concentrations in order to deliver therapeutic doses of the drug to
the tissue surrounding the device or implant; (b) drug localization
techniques such as magnetic, ultrasonic or MRI-guided drug
delivery; (c) chemical modification of the fibrosis-inhibiting (or
gliosis-inhibiting) drug or formulation designed to increase uptake
of the agent into damaged tissues (e.g., antibodies directed
against damaged or healing tissue components such as macrophages,
neutrophils, smooth muscle cells, fibroblasts, extracellular matrix
components, neovascular tissue); (d) chemical modification of the
fibrosis-inhibiting (or gliosis-inhibiting) drug or formulation
designed to localize the drug to areas of bleeding or disrupted
vasculature; and/or (e) direct injection of the fibrosis-inhibiting
(or gliosis-inhibiting) agent, for example, under endoscopic
vision.
[0517] 3) Infiltration of Fibrosis-Inhibiting (or
Gliosis-Inhibiting) Agents into the Tissue Surrounding a Device or
Implant
[0518] Alternatively, the tissue surrounding the CRM or
neurostimulation device can be treated with a fibrosis-inhibiting
(or gliosis-inhibiting) agent prior to, during, or after the
implantation procedure. A fibrosis-inhibiting (or
gliosis-inhibiting) agent or a composition comprising a
fibrosis-inhibiting (or gliosis-inhibiting) agent may be
infiltrated around the device or implant by applying the
composition directly and/or indirectly into and/or onto (a) tissue
adjacent to the medical device; (b) the vicinity of the medical
device-tissue interface; (c) the region around the medical device;
and (d) tissue surrounding the medical device.
[0519] It should be noted that certain polymeric carriers
themselves can help prevent the formation of fibrous or gliotic
tissue around the CRM or neuroimplant. These carriers are
particularly useful for the practice of this embodiment, either
alone, or in combination with a fibrosis (or gliosis) inhibiting
composition. The following polymeric carriers can be infiltrated
(as described in the previous paragraph) into the vicinity of the
electrode-tissue interface and include: (a) sprayable
collagen-containing formulations such as COSTASIS and CT3, either
alone, or loaded with a fibrosis-inhibiting (or gliosis-inhibiting)
agent, applied to the implantation site (or the implant/device
surface); (b) sprayable PEG-containing formulations such as COSEAL,
FOCALSEAL, SPRAYGEL or DURASEAL, either alone, or loaded with a
fibrosis-inhibiting (or gliosis-inhibiting) agent, applied to the
implantation site (or the implant/device surface); (c)
fibrinogen-containing formulations such as FLOSEAL or TISSEAL,
either alone, or loaded with a fibrosis-inhibiting (or
gliosis-inhibiting) agent, applied to the implantation site (or the
implant/device surface); (d) hyaluronic acid-containing
formulations such as RESTYLANE, HYLAFORM, PERLANE, SYNVISC,
SEPRAFILM, SEPRACOAT, InterGel, LUBRICOAT, loaded with a
fibrosis-inhibiting (or gliosis-inhibiting) agent applied to the
implantation site (or the implant/device surface); (e) polymeric
gels for surgical implantation such as REPEL or FLOWGEL loaded with
a fibrosis-inhibiting (or gliosis-inhibiting) agent applied to the
implantation site (or the implant/device surface); (f) orthopedic
"cements" used to hold prostheses and tissues in place loaded with
a fibrosis-inhibiting (or gliosis-inhibiting) agent applied to the
implantation site (or the implant/device surface), such as
OSTEOBOND (Zimmer), low viscosity cement (LVC) (Wright Medical
Technology), SIMPLEX P (Stryker), PALACOS (Smith & Nephew), and
ENDURANCE (Johnson & Johnson, Inc.); (g) surgical adhesives
containing cyanoacrylates such as DERMABOND, INDERMIL, GLUSTITCH,
TISSUMEND, VETBOND, HISTOACRYL BLUE and ORABASE SOOTHE-N-SEAL
LIQUID PROTECTANT, either alone, or loaded with a
fibrosis-inhibiting (or gliosis-inhibiting) agent, applied to the
implantation site (or the implant/device surface); (h) implants
containing hydroxyapatite [or synthetic bone material such as
calcium sulfate, VITOSS (Orthovita) and CORTOSS (Orthovita)] loaded
with a fibrosis-inhibiting (or gliosis-inhibiting) agent applied to
the implantation site (or the implant/device surface); (i) other
biocompatible tissue fillers loaded with a fibrosis-inhibiting (or
gliosis-inhibiting) agent, such as those made by BioCure, 3M
Company and Neomend, applied to the implantation site (or the
implant/device surface); (j) polysaccharide gels such as the ADCON
series of gels either alone, or loaded with a fibrosis-inhibiting
(or gliosis-inhibiting) agent, applied to the implantation site (or
the implant/device surface); and/or (k) films, sponges or meshes
such as INTERCEED, VICRYL mesh, and GELFOA M loaded with a
fibrosis-inhibiting (or gliosis-inhibiting) agent applied to the
implantation site (or the implant/device surface).
[0520] A preferred polymeric matrix which can be used to help
prevent the formation of fibrous or gliotic tissue around the CRM
or neuroimplant, either alone or in combination with a fibrosis (or
gliosis) inhibiting agent/composition, is formed from reactants
comprising either one or both of pentaerythritol poly(ethylene
glycol)ether tetra-sulfhydryl] (4-armed thiol PEG, which includes
structures having a linking group(s) between a sulfhydryl group(s)
and the terminus of the polyethylene glycol backbone) and
pentaerythritol poly(ethylene glycol)ether tetra-succinimidyl
glutarate] (4-armed NHS PEG, which again includes structures having
a linking group(s) between a NHS group(s) and the terminus of the
polyethylene glycol backbone) as reactive reagents. Another
preferred composition comprises either one or both of
pentaerythritol poly(ethylene glycol)ether tetra-amino] (4-armed
amino PEG, which includes structures having a linking group(s)
between an amino group(s) and the terminus of the polyethylene
glycol backbone) and pentaerythritol poly(ethylene glycol)ether
tetra-succinimidyl glutarate] (4-armed NHS PEG, which again
includes structures having a linking group(s) between a NHS
group(s) and the terminus of the polyethylene glycol backbone) as
reactive reagents. Chemical structures for these reactants are
shown in, e.g., U.S. Pat. No. 5,874,500. Optionally, collagen or a
collagen derivative (e.g., methylated collagen) is added to the
poly(ethylene glycol)-containing reactant(s) to form a preferred
crosslinked matrix that can serve as a polymeric carrier for a
therapeutic agent or a stand-alone composition to help prevent the
formation of fibrous or gliotic tissue around the CRM or
neuroimplant.
[0521] 4) Sustained-Release Preparations of Fibrosis-Inhibiting (or
Gliosis-Inhibiting) Agents
[0522] As described previously, desired fibrosis-inhibiting (or
gliosis-inhibiting) agents may be admixed with, blended with,
conjugated to, or, otherwise modified to contain a polymer
composition (which may be either biodegradable or
non-biodegradable), or a non-polymeric composition, in order to
release the therapeutic agent over a prolonged period of time. For
many of the aforementioned embodiments, localized delivery as well
as localized sustained delivery of the fibrosis-inhibiting (or
gliosis-inhibiting) agent may be required. For example, a desired
fibrosis-inhibiting (or gliosis-inhibiting) agent may be admixed
with, blended with, conjugated to, or otherwise modified to contain
a polymeric composition (which may be either biodegradable or
non-biodegradable), or non-polymeric composition, in order to
release the fibrosis-inhibiting (or gliosis-inhibiting) agent over
a period of time. In certain aspects, the polymer composition may
include a bioerodible or biodegradable polymer. Representative
examples of biodegradable polymer compositions suitable for the
delivery of fibrosis-inhibiting (or gliosis-inhibiting) agents
include albumin, collagen, gelatin, hyaluronic acid, starch,
cellulose and cellulose derivatives (e.g., methylcellulose,
hydroxypropylcellulose, hydroxypropylmethylcellulose,
carboxymethylcellulose, cellulose acetate phthalate, cellulose
acetate succinate, hydroxypropylmethylcellulose phthalate), casein,
dextrans, polysaccharides, fibrinogen, poly(ether ester) multiblock
copolymers, based on poly(ethylene glycol) and poly(butylene
terephthalate), tyrosine-derived polycarbonates (e.g., U.S. Pat.
No. 6,120,491), poly(hydroxyl acids), poly(D,L-lactide),
poly(D,L-lactide-co-glycolide), poly(glycolide),
poly(hydroxybutyrate), polydioxanone, poly(alkylcarbonate) and
poly(orthoesters), degradable polyesters (e.g., polyesters
comprising the residues of one or more of the monomers selected
from lactide, lactic acid, glycolide, glycolic acid,
e-caprolactone, gamma-caprolactone, hydroxyvaleric acid,
hydroxybutyric acid, beta-butyrolactone, gamma-butyrolactone,
gamma-valerolactone, .gamma.-decanolactone, .delta.-decanolactone,
trimethylene carbonate, 1,4-dioxane-2-one or 1,5-dioxepan-2one.),
poly(hydroxyvaleric acid), polydioxanone, poly(ethylene
terephthalate), poly(malic acid), poly(tartronic acid),
poly(acrylamides), polyanhydrides, polyphosphazenes, poly(amino
acids), poly(alkylene oxide)-poly(ester) block copolymers (e.g.,
X--Y, X--Y--X or Y--X--Y, R--(Y--X).sub.n, R--(X--Y).sub.n, where X
is a polyalkylene oxide (e.g., poly(ethylene glycol), methoxy
poly(ethylene glycol), poly(propylene glycol), block copolymers of
poly(ethylene oxide) and poly(propylene oxide) (e.g., PLURONIC and
PLURONIC R polymers) and Y is a polyester (e.g., polyester
comprising the residues of one or more of the monomers selected
from lactide, lactic acid, glycolide, glycolic acid,
e-caprolactone, gamma-caprolactone, hydroxyvaleric acid,
hydroxybutyric acid, beta-butyrolactone, gamma-butyrolactone,
gamma-valerolactone, .gamma.-decanolactone, .delta.-decanolactone,
trimethylene carbonate, 1,4-dioxane-2-one or 1,5-dioxepan-2one.), R
is a multifunctional initiator and copolymers as well as blends
thereof)) and their copolymers, branched polymers as well as blends
thereof. (see generally, Ilium, L., Davids, S. S. (eds.) "Polymers
in Controlled Drug Delivery" Wright, Bristol, 1987; Arshady, J.
Controlled Release 17:1-22, 1991; Pitt, Int. J. Phar. 59:173-196,
1990; Holland et al., J. Controlled Release 4:155-0180, 1986)).
[0523] Representative examples of non-degradable polymers suitable
for the delivery of fibrosis-inhibiting (or gliosis-inhibiting)
agents include poly(ethylene-co-vinyl acetate) ("EVA") copolymers,
silicone rubber, acrylic polymers (polyacrylic acid,
polymethylacrylic acid, polymethylmethacrylate, poly(butyl
methacrylate)), poly(alkylcynoacrylate) (e.g.,
poly(ethylcyanoacrylate), poly(butylcya noacrylate)
poly(hexylcyanoacrylate) poly(octylcyanoacrylate)), polyethylene,
polypropylene, polyamides (nylon 6,6), polyurethanes (e.g.,
CHRONOFLEX AR and CHRONOFLEX AL (both from CardioTech Intemational,
Inc., Wobum, Mass.), BIONATE (Polymer Technology Group, Inc.,
Emergyville, Calif.), and PELLETHANE (Dow Chemical Company,
Midland, Mich.)), poly(ester urethanes), poly(ether urethanes),
poly(ester-urea), polyethers (poly(ethylene oxide), poly(propylene
oxide), block copolymers based on ethylene oxide and propylene
oxide (i.e., copolymers of ethylene oxide and propylene oxide
polymers), such as the family of PLURONIC polymers available from
BASF Corporation (Mount Olive, N.J.), and poly(tetramethylene
glycol)), styrene-based polymers (polystyrene, poly(styrene
sulfonic acid), poly(styrene)-block-poly(isobutylene)-block--
poly(styrene), poly(styrene)-poly(isoprene) block copolymers), and
vinyl polymers (polyvinylpyrrolidone, poly(vinyl alcohol),
poly(vinyl acetate phthalate) as well as copolymers and blends
thereof. Polymers may also be developed which are either anionic
(e.g., alginate, carrageenan, carboxymethyl cellulose,
poly(acrylamido-2-methyl propane sulfonic acid) and copolymers
thereof, poly(methacrylic acid and copolymers thereof and
poly(acrylic acid) and copolymers thereof, as well as blends
thereof, or cationic (e.g., chitosan, poly-L-lysine,
polyethylenimine, and poly(allyl amine)) and blends thereof (see
generally, Dunn et al., J. Applied Polymer Sci. 50:353-365, 1993;
Cascone et al., J. Materials Sci.: Materials in Medicine 5:770-774,
1994; Shiraishi et al., Biol. Pharm. Bull. 16(11):1164-1168, 1993;
Thacharodi and Rao, Int'l J. Pharm. 120:115-118, 1995; Miyazaki et
al., Int'l J. Pharm. 118:257-263, 1995).
[0524] Particularly preferred polymeric carriers include
poly(ethylene-co-vinyl acetate), polyurethanes (e.g., CHRONOFLEX
AR, CHRONOFLEX AL, BIONATE, PELLETHANE), poly (D,L-lactic acid)
oligomers and polymers, poly (L-lactic acid) oligomers and
polymers, poly (glycolic acid), copolymers of lactic acid and
glycolic acid, poly (caprolactone), poly (valerolactone),
polyanhydrides, copolymers of poly (caprolactone) or poly (lactic
acid) with a polyethylene glycol (e.g., MePEG), silicone rubbers,
nitrocellulose, poly(styrene)block-poly(isobutylene)-block-poly(-
styrene), poly(acrylate) polymers and blends, admixtures, or
co-polymers of any of the above. Other preferred polymers include
collagen, poly(alkylene oxide)-based polymers, polysaccharides such
as hyaluronic acid, chitosan and fucans, and copolymers of
polysaccharides with degradable polymers.
[0525] Other representative polymers capable of sustained localized
delivery of fibrosis-inhibiting (or gliosis-inhibiting) agents
include carboxylic polymers, polyacetates, polyacrylamides,
polycarbonates, polyethers, polyesters, polyethylenes,
polyvinylbutyrals, polysilanes, polyureas, polyurethanes,
polyurethanes (e.g., CHRONOFLEX AR, CHRONOFLEX AL, BIONATE, AND
PELLETHANE), polyoxides, polystyrenes, polysulfides, polysulfones,
polysulfonides, polyvinylhalides, pyrrolidones, rubbers,
thermal-setting polymers, cross-linkable acrylic and methacrylic
polymers, ethylene acrylic acid copolymers, styrene acrylic
copolymers, vinyl acetate polymers and copolymers, vinyl acetal
polymers and copolymers, epoxy, melamine, other amino resins,
phenolic polymers, and copolymers thereof, water-insoluble
cellulose ester polymers (including cellulose acetate propionate,
cellulose acetate, cellulose acetate butyrate, cellulose nitrate,
cellulose acetate phthalate, and mixtures thereof),
polyvinylpyrrolidone, polyethylene glycols, polyethylene oxide,
polyvinyl alcohol, polyethers, polysaccharides, hydrophilic
polyurethane, polyhydroxyacrylate, dextran, xanthan, hydroxypropyl
cellulose, methyl cellulose, and homopolymers and copolymers of
N-vinylpyrrolidone, N-vinyllactam, N-vinyl butyrolactam, N-vinyl
caprolactam, other vinyl compounds having polar pendant groups,
acrylate and methacrylate having hydrophilic esterifying groups,
hydroxyacrylate, and acrylic acid, and combinations thereof;
cellulose esters and ethers, ethyl cellulose, hydroxyethyl
cellulose, cellulose nitrate, cellulose acetate, cellulose acetate
butyrate, cellulose acetate propionate, polyurethane, polyacrylate,
natural and synthetic elastomers, rubber, acetal, nylon, polyester,
styrene polybutadiene, acrylic resin, polyvinylidene chloride,
polycarbonate, homopolymers and copolymers of vinyl compounds,
polyvinylchloride, polyvinylchloride acetate.
[0526] In one embodiment, all or a portion of the device is coated
with a primer (bonding) layer and a drug release layer, as
described in U.S. ptent application entitled, "Stent with Medicated
Multi-Layer Hybrid Polymer Coating," filed Sep. 16, 2003 (U.S. Ser.
No. 10/662,877).
[0527] In order to develop a hybrid polymer delivery system for
targeted therapy, it is desirable to be able to control and
manipulate the properties of the system both in terms of physical
and drug release characteristics. The active agents can be imbibed
into a surface hybrid polymer layer, or incorporated directly into
the hybrid polymer coating solutions. Imbibing drugs into surface
polymer layers is an efficient method for evaluating polymer-drug
performance in the laboratory, but for commercial production it may
be preferred for the polymer and drug to be premixed in the casting
mixture. Greater efficacy can be achieved by combining the two
elements in the coating mixtures in order to control the ratio of
active agent to polymer in the coatings. Such ratios are important
parameters to the final properties of the medicated layers, i.e.,
they allow for better control of active agent concentration and
duration of pharmacological activity.
[0528] Typical polymers used in the drug-release system can include
water-insoluble cellulose esters, various polyurethane polymers
including hydrophilic and hydrophobic versions, hydrophilic
polymers such as polyethylene glycol (PEG), polyethylene oxide
(PEO), polyvinylpyrrolidone (PVP), PVP copolymers such as vinyl
acetate, hydroxyethyl methacrylate (HEMA) and copolymers such as
methylmethacrylate (PMMA-HEMA), and other hydrophilic and
hydrophobic acrylate polymers and copolymers containing functional
groups such as carboxyl and/or hydroxyl.
[0529] Cellulose esters such as cellulose acetate, cellulose
acetate propionate, cellulose acetate butyrate, cellulose acetate
phthalate, and cellulose nitrate may be used. In one aspect of the
invention, the therapeutic agent is formulated with a cellulose
ester. Cellulose nitrate is a preferred cellulose ester because of
its compatibility with the active agents and its ability to impart
non-tackiness and cohesiveness to the coatings. Cellulose nitrate
has been shown to stabilize entrapped drugs in ambient and
processing conditions. Various grades of cellulose nitrate are
available and may be used in a coating on a electrical device,
including cellulose nitrate having a nitrogen content=11.8-12.2%.
Various viscosity grades, including 3.5, 0.5 or 0.25 seconds, may
be used in order to provide proper Theological properties when
combined with the coating solids used in these formulations. Higher
or lower viscosity grades can be used. However, the higher
viscosity grades can be more difficult to use because of their
higher viscosities. Thus, the lower viscosity grades, such as 3.5,
0.5 or 0.25 seconds, are generally preferred. Physical properties
such as tensile strength, elongation, flexibility, and softening
point are related to viscosity (molecular weight) and can decrease
with the lower molecular weight species, especially below the 0.25
second grades.
[0530] The cellulose derivatives comprise hydroglucose structures.
Cellulose nitrate is a hydrophobic, water-insoluble polymer, and
has high water resistance properties. This structure leads to high
compatibility with many active agents, accounting for the high
degree of stabilization provided to drugs entrapped in cellulose
nitrate. The structure of nitrocellulose is given below: 110
[0531] Cellulose nitrate is a hard, relatively inflexible polymer,
and has limited adhesion to many polymers that are typically used
to make medical devices. Also, control of drug elution dynamics is
limited if only one polymer is used in the binding matrix.
Accordingly, in one embodiment of the invention, the therapeutic
agent is formulated with two or more polymers before being
associated with the electrical device. In one aspect, the agent is
formulated with both polyurethane ((e.g., CHRONOFLEX AR, CHRONOFLEX
AL, BIONATE, and PELLETHANE) and cellulose nitrate to provide a
hybrid polymer drug loaded matrix. Polyurethanes provide the hybrid
polymer matrix with greater flexibility and adhesion to the
electrical device, particularly when the connector has been
pre-coated with a primer. Polyurethanes can also be used to slow or
hasten the drug elution from coatings. Aliphatic, aromatic,
polytetramethylene ether glycol, and polycarbonate are among the
types of polyurethanes, which can be used in the coatings. In one
aspect, an anti-scarring agent (e.g., paclitaxel) may be
incorporated into a carrier that includes a polyurethane and a
cellulose derivative. A heparin complex, such as benzalkonium
heparinate or tridodecylammonium heparinate), may optionally be
included in the formulation.
[0532] From the structure below, it is possible to see how more or
less hydrophilic polyurethane polymers may be created based on the
number of hydrophilic groups contained in the polymer structures.
In one aspect of the invention, the electrical device is associated
with a formulation that includes therapeutic agent, cellulose
ester, and a polyurethane that is water-insoluble, flexible, and
compatible with the cellulose ester. 111
[0533] Polyvinylpyrrolidone (PVP) is a polyamide that possesses
unusual complexing and colloidal properties and is essentially
physiologically inert. PVP and other hydrophilic polymers are
typically biocompatible. PVP may be incorporated into drug loaded
hybrid polymer compositions in order to increase drug release
rates. In one embodiment, the concentration of PVP that is used in
drug loaded hybrid polymer compositions can be less than 20%. This
concentration can not make the layers bioerodable or lubricious. In
general, PVP concentrations from <1 % to greater than 80% are
deemed workable. In one aspect of the invention, the therapeutic
agent that is associated with a electrical device is formulated
with a PVP polymer. 112
[0534] Acrylate polymers and copolymers including
polymethylmethacrylate (PMMA) and polymethylmethacrylate
hydroxyethyl methacrylate (PMMA/HEMA) are known for their
biocompatibility as a result of their widespread use in contact and
intraocular lens applications. This class of polymer generally
provokes very little smooth muscle and endothelial cell growth, and
very low inflammatory response (Bar). These polymers/copolymers are
compatible with drugs and the other polymers and layers of the
instant invention. Thus, in one aspect, the device is associated
with a composition that comprises a anti-scarring agent as
described above, and an acrylate polymer or copolymer. 113
[0535] Methylmethacrylate hydroxyethylmethacrylate copolymer
[0536] Representative examples of patents relating to drug-delivery
polymers and their preparation include PCT Publication Nos. WO
98/19713, WO 01/17575, WO 01/41821, WO 01/41822, and WO 01/15526
(as well as their corresponding U.S. applications), and U.S. Pat.
Nos. 4,500,676, 4,582,865, 4,629,623, 4,636,524, 4,713,448,
4,795,741, 4,913,743, 5,069,899, 5,099,013, 5,128,326, 5,143,724,
5,153,174, 5,246,698, 5,266,563, 5,399,351, 5,525,348, 5,800,412,
5,837,226, 5,942,555, 5,997,517, 6,007,833, 6,071,447, 6,090,995,
6,106,473, 6,110,483, 6,121,027, 6,156,345, 6,214,901, 6,368,611
6,630,155, 6,528,080, RE37,950, 6,46,1631, 6,143,314, 5,990,194,
5,792,469, 5,780,044, 5,759,563, 5,744,153, 5,739,176, 5,733,950,
5,681,873, 5,599,552, 5,340,849, 5,278,202, 5,278,201, 6,589,549,
6,287,588, 6,201,072, 6,117,949, 6,004,573, 5,702,717, 6,413,539,
and 5,714,159, 5,612,052 and U.S. patent application Publication
Nos. 2003/0068377, 2002/0192286, 2002/0076441, and
2002/0090398.
[0537] It should be obvious to one of skill in the art that the
polymers as described herein can also be blended or copolymerized
in various compositions as required to deliver therapeutic doses of
fibrosis-inhibiting (or gliosis-inhibiting) agents.
[0538] Polymeric carriers for fibrosis-inhibiting (or
gliosis-inhibiting) agents can be fashioned in a variety of forms,
with desired release characteristics and/or with specific
properties depending upon the device, composition or implant being
utilized. For example, polymeric carriers may be fashioned to
release a fibrosis-inhibiting (or gliosis-inhibiting) agent upon
exposure to a specific triggering event such as pH (see, e.g.,
Heller et al., "Chemically Self-Regulated Drug Delivery Systems,"
in Polymers in Medicine III, Elsevier Science Publishers B. V.,
Amsterdam, 1988, pp. 175-188; Kang et al., J. Applied Polymer Sci.
48:343-354, 1993; Dong et al., J. Controlled Release 19:171-178,
1992; Dong and Hoffman, J. Controlled Release 15:141-152, 1991; Kim
et al., J. Controlled Release 28:143-152, 1994; Cornejo-Bravo et
al., J. Controlled Release 33:223-229, 1995; Wu and Lee, Pharm.
Res. 10(10):1544-1547, 1993; Serres et al., Pharm. Res.
13(2):196-201, 1996; Peppas, "Fundamentals of pH- and
Temperature-Sensitive Delivery Systems," in Gumy et al. (eds.),
Pulsatile Drug Delivery, Wissenschaftliche Verlagsgesellschaft mbH,
Stuttgart, 1993, pp. 41-55; Doelker, "Cellulose Derivatives," 1993,
in Peppas and Langer (eds.), Biopolymers I, Springer-Verlag,
Berlin). Representative examples of pH-sensitive polymers include
poly(acrylic acid) and its derivatives (including for example,
homopolymers such as poly(aminocarboxylic acid); poly(acrylic
acid); poly(methyl acrylic acid), copolymers of such homopolymers,
and copolymers of poly(acrylic acid) and/or acrylate or acrylamide
Imonomers such as those discussed above. Other pH sensitive
polymers include polysaccharides such as cellulose acetate
phthalate; hydroxypropylmethylcellulose phthalate;
hydroxypropylmethylcellulose acetate succinate; cellulose acetate
trimellilate; and chitosan. Yet other pH sensitive polymers include
any mixture of a pH sensitive polymer and a water-soluble
polymer.
[0539] Likewise, fibrosis-inhibiting (or gliosis-inhibiting) agents
can be delivered via polymeric carriers which are temperature
sensitive (see, e.g., Chen et al., "Novel Hydrogels of a
Temperature-Sensitive PLURONIC Grafted to a Bioadhesive Polyacrylic
Acid Backbone for Vaginal Drug Delivery," in Proceed. Intern. Symp.
Control. Rel. Bioact. Mater. 22:167-168, Controlled Release
Society, Inc., 1995; Okano, "Molecular Design of Stimuli-Responsive
Hydrogels for Temporal Controlled Drug Delivery," in Proceed.
Intern. Symp. Control. Rel. Bioact. Mater. 22:111-112, Controlled
Release Society, Inc., 1995; Johnston et al., Pharm. Res.
9(3):425-433, 1992; Tung, Int'l J. Pharm. 107:85-90, 1994; Harsh
and Gehrke, J. Controlled Release 17:175-186, 1991; Bae et al.,
Pharm. Res. 8(4):531-537, 1991; Dinarvand and D'Emanuele, J.
Controlled Release 36:221-227, 1995; Yu and Grainger, "Novel
Thermo-sensitive Amphiphilic Gels: Poly
N-isopropylacrylamide-co-sodium acrylate-co-n-N-alkylacrylamide
Network Synthesis and Physicochemical Characterization," Dept. of
Chemical & Biological Sci., Oregon Graduate Institute of
Science & Technology, Beaverton, Oreg., pp. 820-821; Zhou and
Smid, "Physical Hydrogels of Associative Star Polymers," Polymer
Research Institute, Dept. of Chemistry, College of Environmental
Science and Forestry, State Univ. of New York, Syracuse, N.Y., pp.
822-823; Hoffman et al., "Characterizing Pore Sizes and Water
`Structure` in Stimuli-Responsive Hydrogels," Center for
Bioengineering, Univ. of Washington, Seattle, Wash., p. 828; Yu and
Grainger, "Thermo-sensitive Swelling Behavior in Crosslinked
N-isopropylacrylamide Networks: Cationic, Anionic and Ampholytic
Hydrogels," Dept. of Chemical & Biological Sci., Oregon
Graduate Institute of Science & Technology, Beaverton, Oreg.,
pp. 829-830; Kim et al., Pharm. Res. 9(3):283-290, 1992; Bae et
al., Pharm. Res. 8(5):624-628, 1991; Kono et al., J. Controlled
Release 30:69-75, 1994; Yoshida et al., J. Controlled Release
32:97-102, 1994; Okano et al., J. Controlled Release 36:125-133,
1995; Chun and Kim, J. Controlled Release 38:39-47, 1996;
D'Emanuele and Dinarvand, Int'l J. Pharm. 118:237-242, 1995; Katono
et al., J. Controlled Release 16:215-228, 1991; Hoffman, "Thermally
Reversible Hydrogels Containing Biologically Active Species," in
Migliaresi et al. (eds.), Polymers in Medicine III, Elsevier
Science Publishers B. V., Amsterdam, 1988, pp. 161-167; Hoffman,
"Applications of Thermally Reversible Polymers and Hydrogels in
Therapeutics and Diagnostics," in Third Intemational Symposium on
Recent Advances in Drug Delivery Systems, Salt Lake City, Utah,
Feb. 24-27, 1987, pp. 297-305; Gutowska et al., J. Controlled
Release 22:95-104, 1992; Palasis and Gehrke, J. Controlled Release
18:1-12, 1992; Paavola et al., Pharm. Res. 12(12):1997-2002,
1995).
[0540] Representative examples of thermogelling polymers, and their
gelatin temperature (LCST (.degree.C.)) include homopolymers such
as poly(N-methyl-N-n-propylacrylamide), 19.8;
poly(N-n-propylacrylamide), 21.5;
poly(N-methyl-N-isopropylacrylamide), 22.3;
poly(N-n-propylmethacry- lamide), 28.0;
poly(N-isopropylacrylamide), 30.9; poly(N,n-diethylacrylami- de),
32.0; poly(N-isopropylmethacrylamide), 44.0;
poly(N-cyclopropylacryla- mide), 45.5;
poly(N-ethylmethyacrylamide), 50.0; poly(N-methyl-N-ethylacry-
lamide), 56.0; poly(N-cyclopropylmethacrylamide), 59.0;
poly(N-ethylacrylamide), 72.0. Moreover thermogelling polymers may
be made by preparing copolymers between (among) monomers of the
above, or by combining such homopolymers with other water-soluble
polymers such as acrylmonomers (e.g., acrylic acid and derivatives
thereof, such as methylacrylic acid, acrylate monomers and
derivatives thereof, such as butyl methacrylate, butyl acrylate,
lauryl acrylate, and acrylamide monomers and derivatives thereof,
such as N-butyl acrylamide and acrylamide).
[0541] Other representative examples of thermogelling polymers
include cellulose ether derivatives such as hydroxypropyl
cellulose, 41.degree. C.; methyl cellulose, 55.degree. C.;
hydroxypropylmethyl cellulose, 66.degree. C.; and ethylhydroxyethyl
cellulose, polyalkylene oxide-polyester block copolymers of the
structure X--Y, Y--X--Y and X--Y--X where X in a polyalkylene oxide
and Y is a biodegradable polyester (e.g., PLG-PEG-PLG) and
PLURONICs such as F-127, 10-15.degree. C.; L-122, 19.degree. C.;
L-92, 26.degree. C.; L-81, 20.degree. C.; and L-61, 24.degree.
C.
[0542] Representative examples of patents relating to thermally
gelling polymers and their preparation include U.S. Pat. Nos.
6,451,346; 6,201,072; 6,117,949; 6,004,573; 5,702,717; and
5,484,610 and PCT Publication Nos. WO 99/07343; WO 99/18142; WO
03/17972; WO 01/82970; WO 00/18821; WO 97/15287; WO 01/41735; WO
00/00222 and WO 00/38651.
[0543] Fibrosis-inhibiting (or gliosis-inhibiting) agents may be
linked by occlusion in the matrices of the polymer, bound by
covalent linkages, or encapsulated in microcapsules. Within certain
embodiments of the invention, therapeutic compositions are provided
in non-capsular formulations such as microspheres (ranging from
nanometers to micrometers in size), pastes, threads of various
size, films and sprays.
[0544] Within certain aspects of the present invention, therapeutic
compositions may be fashioned into particles having any size
ranging from 50 nm to 500 .mu.m, depending upon the particular use.
These compositions can be in the form of microspheres,
microparticles and/or nanoparticles. These compositions can be
formed by spray-drying methods, milling methods, coacervation
methods, W/O emulsion methods, W/O/W emulsion methods, and solvent
evaporation methods. In another embodiment, these compositions can
include microemulsions, emulsions, liposomes and micelles.
Alternatively, such compositions may also be readily applied as a
"spray", which solidifies into a film or coating for use as a
device/implant surface coating or to line the tissues of the
implantation site. Such sprays may be prepared from microspheres of
a wide array of sizes, including for example, from 0.1 .mu.m to 3
.mu.m, from 10 .mu.m to 30 .mu.m, and from 30 .mu.m to 100
.mu.m.
[0545] Therapeutic compositions of the present invention may also
be prepared in a variety of paste or gel forms. For example, within
one embodiment of the invention, therapeutic compositions are
provided which are liquid at one temperature (e.g., temperature
greater than 37.degree. C., such as 40.degree. C., 45.degree. C.,
50.degree. C., 55.degree. C. or 60.degree. C.), and solid or
semi-solid at another temperature (e.g., ambient body temperature,
or any temperature lower than 37.degree. C.). Such "thermopastes"
may be readily made utilizing a variety of techniques (see, e.g.,
PCT Publication WO 98/24427). Other pastes may be applied as a
liquid, which solidify in vivo due to dissolution of a
water-soluble component of the paste and precipitation of
encapsulated drug into the aqueous body environment. These "pastes"
and "gels" containing fibrosis-inhibiting agents are particularly
useful for application to the surface of tissues that will be in
contact with the implant or device.
[0546] Within yet other aspects of the invention, the therapeutic
compositions of the present invention may be formed as a film or
tube. These films or tubes can be porous or non-porous. Such films
or tubes are generally less than 5, 4, 3, 2, or 1 mm thick, or less
than 0.75 mm, or less than 0.5 mm, or less than 0.25 mm, or, less
than 0.10 mm thick. Films or tubes can also be generated of
thicknesses less than 50 .mu.m, 25 .mu.m or 10 .mu.m. Such films
may be flexible with a good tensile strength (e.g., greater than
50, or greater than 100, or greater than 150 or 200 N/cm.sup.2),
good adhesive properties (i.e., adheres to moist or wet surfaces),
and have controlled permeability. Fibrosis-inhibiting agents
contained in polymeric films are particularly useful for
application to the surface of a device or implant as well as to the
surface of tissue, cavity or an organ.
[0547] Within further aspects of the present invention, polymeric
carriers are provided which are adapted to contain and release a
hydrophobic fibrosis-inhibiting (or gliosis-inhibiting) compound,
and/or the carrier containing the hydrophobic compound in
combination with a carbohydrate, protein or polypeptide. Within
certain embodiments, the polymeric carrier contains or comprises
regions, pockets, or granules of one or more hydrophobic compounds.
For example, within one embodiment of the invention, hydrophobic
compounds may be incorporated within a matrix which contains the
hydrophobic fibrosis-inhibiting (or gliosis-inhibiting) compound,
followed by incorporation of the matrix within the polymeric
carrier. A variety of matrices can be utilized in this regard,
including for example, carbohydrates and polysaccharides such as
starch, cellulose, dextran, methylcellulose, sodium alginate,
heparin, chitosan, hyaluronic acid, proteins or polypeptides such
as albumin, collagen and gelatin. Within alternative embodiments,
hydrophobic compounds may be contained within a hydrophobic core,
and this core contained within a hydrophilic shell.
[0548] Other carriers that may likewise be utilized to contain and
deliver fibrosis-inhibiting (or gliosis-inhibiting) agents
described herein include: hydroxypropyl cyclodextrin (Cserhati and
Hollo, Int. J. Pharm. 108:69-75, 1994), liposomes (see, e.g.,
Sharma et al., Cancer Res. 53:5877-5881, 1993; Sharma and
Straubinger, Pharm. Res. 11(60):889-896, 1994; WO 93/18751; U.S.
Pat. No. 5,242,073), liposome/gel (WO 94/26254), nanocapsules
(Bartoli et al., J. Microencapsulation 7(2):191-197, 1990),
micelles (Alkan-Onyuksel et al., Pharm. Res. 11(2):206-212, 1994),
implants (Jampel et al., Invest. Ophthalm. Vis. Science
34(11):3076-3083, 1993; Walter et al., Cancer Res. 54:22017-2212,
1994), nanoparticles (Violante and Lanzafame PMCR),
nanoparticles-modified (U.S. Pat. No. 5,145,684), nanoparticles
(surface modified) (U.S. Pat. No. 5,399,363), micelle (surfactant)
(U.S. Pat. No. 5,403,858), synthetic phospholipid compounds (U.S.
Pat. No. 4,534,899), gas borne dispersion (U.S. Pat. No.
5,301,664), liquid emulsions, foam, spray, gel, lotion, cream,
ointment, dispersed vesicles, particles or droplets solid- or
liquid-aerosols, microemulsions (U.S. Pat. No. 5,330,756),
polymeric shell (nano- and micro-capsule) (U.S. Pat. No.
5,439,686), emulsion (Tarr et al., Pharm Res. 4: 62-165, 1987),
nanospheres (Hagan et al., Proc. Intern. Symp. Control Rel. Bioact.
Mater. 22, 1995; Kwon et al., Pharm Res. 12(2):192-195; Kwon et
al., Pharm Res. 10(7):970-974; Yokoyama et al., J. Contr. Rel.
32:269-277, 1994; Gref et al., Science 263:1600-1603, 1994; Bazile
et al., J. Pharm. Sci. 84:493-498, 1994) and implants (U.S. Pat.
No. 4,882,168).
[0549] Within another aspect of the present invention, polymeric
carriers can be materials that are formed in situ. In one
embodiment, the precursors can be monomers or macromers that
contain unsaturated groups that can be polymerized and/or
cross-linked. The monomers or macromers can then, for example, be
injected into the treatment area or onto the surface of the
treatment area and polymerized in situ using a radiation source
(e.g., visible light, UV light) or a free radical system (e.g.,
potassium persulfate and ascorbic acid or iron and hydrogen
peroxide). The polymerization step can be performed immediately
prior to, simultaneously to or post injection of the reagents into
the treatment site. Representative examples of compositions that
undergo free radical polymerization reactions are described in WO
01/44307, WO 01/68720, WO 02/072166, WO 03/043552, WO 93/17669, WO
00/64977, U.S. Pat. Nos. 5,900,245, 6,051,248, 6,083,524,
6,177,095, 6,201,065, 6,217,894, 6,639,014, 6,352,710, 6,410,645,
6,531,147, 5,567,435, 5,986,043, 6,602,975, and U.S. patent
application Publication Nos. 2002/012796A1, 2002/0127266A1,
2002/0151650A1, 2003/0104032A1, 2002/0091229A1, and
2003/0059906A1.
[0550] As mentioned elsewhere herein, the present invention
provides for polymeric crosslinked matrices, and polymeric
carriers, that may be used to assist in the prevention of the
formation or growth of fibrous connective tissue or glial tissue.
The composition may contain and deliver fibrosis-inhibiting (or
gliosis-inhibiting) agents in the vicinity of the medical device.
The following compositions are particularly useful when it is
desired to infiltrate around the device, with or without a
fibrosis-inhibiting agent. Such polymeric materials may be prepared
from, e.g., (a) synthetic materials, (b) naturally-occurring
materials, or (c) mixtures of synthetic and naturally occurring
materials. The matrix may be prepared from, e.g., (a) a
one-component, i.e., self-reactive, compound, or (b) two or more
compounds that are reactive with one another. Typically, these
materials are fluid prior to delivery, and thus can be sprayed or
otherwise extruded from a device in order to deliver the
composition. After delivery, the component materials react with
each other, and/or with the body, to provide the desired affect. In
some instances, materials that are reactive with one another must
be kept separated prior to delivery to the patient, and are mixed
together just prior to being delivered to the patient, in order
that they maintain a fluid form prior to delivery. In a preferred
aspect of the invention, the components of the matrix are delivered
in a liquid state to the desired site in the body, whereupon in
situ polymerization occurs.
[0551] First and Second Synthetic Polymers
[0552] In one embodiment, crosslinked polymer compositions (in
other words, crosslinked matrices) are prepared by reacting a first
synthetic polymer containing two or more nucleophilic groups with a
second synthetic polymer containing two or more electrophilic
groups, where the electrophilic groups are capable of covalently
binding with the nucleophilic groups. In one embodiment, the first
and second polymers are each non-immunogenic. In another
embodiment, the matrices are not susceptible to enzymatic cleavage
by, e.g., a matrix metalloproteinase (e.g., collagenase) and are
therefore expected to have greater long-term persistence in vivo
than collagen-based compositions.
[0553] As used herein, the term "polymer" refers inter alia to
polyalkyls, polyamino acids, polyalkyleneoxides and
polysaccharides. Additionally, for external or oral use, the
polymer may be polyacrylic acid or carbopol. As used herein, the
term "synthetic polymer" refers to polymers that are not naturally
occurring and that are produced via chemical synthesis. As such,
naturally occurring proteins such as collagen and naturally
occurring polysaccharides such as hyaluronic acid are specifically
excluded. Synthetic collagen, and synthetic hyaluronic acid, and
their derivatives, are included. Synthetic polymers containing
either nucleophilic or electrophilic groups are also referred to
herein as "multifunctionally activated synthetic polymers." The
term "multifunctionally activated" (or, simply, "activated") refers
to synthetic polymers which have, or have been chemically modified
to have, two or more nucleophilic or electrophilic groups which are
capable of reacting with one another (i.e., the nucleophilic groups
react with the electrophilic groups) to form covalent bonds. Types
of multifunctionally activated synthetic polymers include
difunctionally activated, tetrafunctionally activated, and
star-branched polymers.
[0554] Multifunctionally activated synthetic polymers for use in
the present invention must contain at least two, more preferably,
at least three, functional groups in order to form a
three-dimensional crosslinked network with synthetic polymers
containing multiple nucleophilic groups (i.e., "multi-nucleophilic
polymers"). In other words, they must be at least difunctionally
activated, and are more preferably trifunctionally or
tetrafunctionally activated. If the first synthetic polymer is a
difunctionally activated synthetic polymer, the second synthetic
polymer must contain three or more functional groups in order to
obtain a three-dimensional crosslinked network. Most preferably,
both the first and the second synthetic polymer contain at least
three functional groups.
[0555] Synthetic polymers containing multiple nucleophilic groups
are also referred to generically herein as "multi-nucleophilic
polymers." For use in the present invention, multi-nucleophilic
polymers must contain at least two, more preferably, at least
three, nucleophilic groups. If a synthetic polymer containing only
two nucleophilic groups is used, a synthetic polymer containing
three or more electrophilic groups must be used in order to obtain
a three-dimensional crosslinked network.
[0556] Preferred multi-nucleophilic polymers for use in the
compositions and methods of the present invention include synthetic
polymers that contain, or have been modified to contain, multiple
nucleophilic groups such as primary amino groups and thiol groups.
Preferred multi-nucleophilic polymers include: (i) synthetic
polypeptides that have been synthesized to contain two or more
primary amino groups or thiol groups; and (ii) polyethylene glycols
that have been modified to contain two or more primary amino groups
or thiol groups. In general, reaction of a thiol group with an
electrophilic group tends to proceed more slowly than reaction of a
primary amino group with an electrophilic group.
[0557] In one embodiment, the multi-nucleophilic polypeptide is a
synthetic polypeptide that has been synthesized to incorporate
amino acid residues containing primary amino groups (such as
lysine) and/or amino acids containing thiol groups (such as
cysteine). Poly(lysine), a synthetically produced polymer of the
amino acid lysine (145 MW), is particularly preferred.
Poly(lysine)s have been prepared having anywhere from 6 to about
4,000 primary amino groups, corresponding to molecular weights of
about 870 to about 580,000.
[0558] Poly(lysine)s for use in the present invention preferably
have a molecular weight within the range of about 1,000 to about
300,000; more preferably, within the range of about 5,000 to about
100,000; most preferably, within the range of about 8,000 to about
15,000. Poly(lysine)s of varying molecular weights are commercially
available from Peninsula Laboratories, Inc. (Belmont, Calif.) and
Aldrich Chemical (Milwaukee, Wis.).
[0559] Polyethylene glycol can be chemically modified to contain
multiple primary amino or thiol groups according to methods set
forth, for example, in Chapter 22 of Poly(ethylene Glycol)
Chemistry: Biotechnical and Biomedical Applications, J. Milton
Harris, ed., Plenum Press, N.Y. (1992). Polyethylene glycols which
have been modified to contain two or more primary amino groups are
referred to herein as "multi-amino PEGs." Polyethylene glycols
which have been modified to contain two or more thiol groups are
referred to herein as "multi-thiol PEGs." As used herein, the term
"polyethylene glycol(s)" includes modified and or derivatized
polyethylene glycol(s).
[0560] Various forms of multi-amino PEG are commercially available
from Shearwater Polymers (Huntsville, Ala.) and from Huntsman
Chemical Company (Utah) under the name "Jeffamine." Multi-amino
PEGs useful in the present invention include Huntsman's Jeffamine
diamines ("D" series) and triamines ("T" series), which contain two
and three primary amino groups per molecule, respectively.
[0561] Polyamines such as ethylenediamine
(H.sub.2N--CH.sub.2--CH.sub.2--N- H.sub.2), tetramethylenediamine
(H.sub.2N--(CH.sub.2).sub.4--NH.sub.2), pentamethylenediamine
(cadaverine) (H.sub.2N--(CH.sub.2).sub.5--NH.sub.2)- ,
hexamethylenediamine (H.sub.2N--(CH.sub.2).sub.6--NH.sub.2),
di(2-aminoethyl)amine (HN--(CH.sub.2--CH.sub.2--NH.sub.2).sub.2),
and tris(2-aminoethyl)amine
(N--(CH.sub.2--CH.sub.2--NH.sub.2).sub.3) may also be used as the
synthetic polymer containing multiple nucleophilic groups.
[0562] Synthetic polymers containing multiple electrophilic groups
are also referred to herein as "multi-electrophilic polymers." For
use in the present invention, the multifunctionally activated
synthetic polymers must contain at least two, more preferably, at
least three, electrophilic groups in order to form a
three-dimensional crosslinked network with multi-nucleophilic
polymers. Preferred multi-electrophilic polymers for use in the
compositions of the invention are polymers which contain two or
more succinimidyl groups capable of forming covalent bonds with
nucleophilic groups on other molecules. Succinimidyl groups are
highly reactive with materials containing primary amino (NH.sub.2)
groups, such as multi-amino PEG, poly(lysine), or collagen.
Succinimidyl groups are slightly less reactive with materials
containing thiol (SH) groups, such as multi-thiol PEG or synthetic
polypeptides containing multiple cysteine residues.
[0563] As used herein, the term "containing two or more
succinimidyl groups" is meant to encompass polymers which are
preferably commercially available containing two or more
succinimidyl groups, as well as those that must be chemically
derivatized to contain two or more succinimidyl groups. As used
herein, the term "succinimidyl group" is intended to encompass
sulfosuccinimidyl groups and other such variations of the "generic"
succinimidyl group. The presence of the sodium sulfite moiety on
the sulfosuccinimidyl group serves to increase the solubility of
the polymer.
[0564] Hydrophilic polymers and, in particular, various derivatized
polyethylene glycols, are preferred for use in the compositions of
the present invention. As used herein, the term "PEG" refers to
polymers having the repeating structure
(OCH.sub.2--CH.sub.2).sub.n. Structures for some specific,
tetrafunctionally activated forms of PEG are shown in FIGS. 4 to 13
of U.S. Pat. No. 5,874,500, incorporated herein by reference.
Examples of suitable PEGS include PEG succinimidyl propionate
(SE-PEG), PEG succinimidyl succinamide (SSA-PEG), and PEG
succinimidyl carbonate (SC-PEG). In one aspect of the invention,
the crosslinked matrix is formed in situ by reacting
pentaerythritol poly(ethylene glycol)ether tetra-sulfhydryl]
(4-armed thiol PEG) and pentaerythritol poly(ethylene glycol)ether
tetra-succinimidyl glutarate] (4-armed NHS PEG) as reactive
reagents. Structures for these reactants are shown in U.S. Pat. No.
5,874,500. Each of these materials has a core with a structure that
may be seen by adding ethylene oxide-derived residues to each of
the hydroxyl groups in pentaerythritol, and then derivatizing the
terminal hydroxyl groups (derived from the ethylene oxide) to
contain either thiol groups (so as to form 4-armed thiol PEG) or
N-hydroxysuccinimydyl groups (so as to form 4-armed NHS PEG),
optionally with a linker group present between the ethylene oxide
derived backbone and the reactive functional group, where this
product is commercially available as COSEAL from Angiotech
Pharmaceuticals Inc. Optionally, a group "D" may be present in one
or both of these molecules, as discussed in more detail below.
[0565] As discussed above, preferred activated polyethylene glycol
derivatives for use in the invention contain succinimidyl groups as
the reactive group. However, different activating groups can be
attached at sites along the length of the PEG molecule. For
example, PEG can be derivatized to form functionally activated PEG
propionaldehyde (A-PEG), or functionally activated PEG glycidyl
ether (E-PEG), or functionally activated PEG-isocyanate (I-PEG), or
functionally activated PEG-vinylsulfone (V-PEG).
[0566] Hydrophobic polymers can also be used to prepare the
compositions of the present invention. Hydrophobic polymers for use
in the present invention preferably contain, or can be derivatized
to contain, two or more electrophilic groups, such as succinimidyl
groups, most preferably, two, three, or four electrophilic groups.
As used herein, the term "hydrophobic polymer" refers to polymers
which contain a relatively small proportion of oxygen or nitrogen
atoms.
[0567] Hydrophobic polymers which already contain two or more
succinimidyl groups include, without limitation, disuccinimidyl
suberate (DSS), bis(sulfosuccinimidyl)suberate (BS3),
dithiobis(succinimidylpropionate) (DSP),
bis(2-succinimidooxycarbonyloxy)ethyl sulfone (BSOCOES), and
3,3'--dithiobis(sulfosuccinimidylpropionate (DTSPP), and their
analogs and derivatives. The above-referenced polymers are
commercially available from Pierce (Rockford, Ill.), under catalog
Nos. 21555, 21579, 22585, 21554, and 21577, respectively.
[0568] Preferred hydrophobic polymers for use in the invention
generally have a carbon chain that is no longer than about 14
carbons. Polymers having carbon chains substantially longer than 14
carbons generally have very poor solubility in aqueous solutions
and, as such, have very long reaction times when mixed with aqueous
solutions of synthetic polymers containing multiple nucleophilic
groups.
[0569] Certain polymers, such as polyacids, can be derivatized to
contain two or more functional groups, such as succinimidyl groups.
Polyacids for use in the present invention include, without
limitation, trimethylolpropane-based tricarboxylic acid,
di(trimethylol propane)-based tetracarboxylic acid, heptanedioic
acid, octanedioic acid (suberic acid), and hexadecanedioic acid
(thapsic acid). Many of these polyacids are commercially available
from DuPont Chemical Company (Wilmington, Del.). According to a
general method, polyacids can be chemically derivatized to contain
two or more succinimidyl groups by reaction with an appropriate
molar amount of N-hydroxysuccinimide (NHS) in the presence of
N,N'-dicyclohexylca rbodiimide (DCC).
[0570] Polyalcohols such as trimethylolpropane and di(trimethylol
propane) can be converted to carboxylic acid form using various
methods, then further derivatized by reaction with NHS in the
presence of DCC to produce trifunctionally and tetrafunctionally
activated polymers, respectively, as described in U.S. application
Ser. No. 08/403,358. Polyacids such as heptanedioic acid
(HOOC--(CH.sub.2).sub.5--COOH), octanedioic acid
(HOOC--(CH.sub.2).sub.6--COOH), and hexadecanedioic acid
(HOOC--(CH.sub.2).sub.14--COOH) are derivatized by the addition of
succinimidyl groups to produce difunctionally activated
polymers.
[0571] Polyamines such as ethylenediamine, tetramethylenediamine,
pentamethylenediamine (cadaverine), hexamethylenediamine,
bis(2-aminoethyl)amine, and tris(2-aminoethyl)amine can be
chemically derivatized to polyacids, which can then be derivatized
to contain two or more succinimidyl groups by reacting with the
appropriate molar amounts of N-hydroxysuccinimide in the presence
of DCC, as described in U.S. application Ser. No. 08/403,358. Many
of these polyamines are commercially available from DuPont Chemical
Company.
[0572] In a preferred embodiment, the first synthetic polymer will
contain multiple nucleophilic groups (represented below as "X") and
it will react with the second synthetic polymer containing multiple
electrophilic groups (represented below as "Y"), resulting in a
covalently bound polymer network, as follows:
Polymer-X.sub.m+Polymer-Y.sub.n.fwdarw.Polymer-Z-Polymer
[0573] wherein m.ltoreq.2, n.ltoreq.2, and m+n.ltoreq.5;
[0574] where exemplary X groups include --NH.sub.2, --SH, --OH,
--PH.sub.2, CO--NH--NH.sub.2, etc., where the X groups may be the
same or different in polymer-X.sub.m;
[0575] where exemplary Y groups include
--CO.sub.2--N(COCH.sub.2).sub.2, --CO.sub.2H, --CHO, --CHOCH.sub.2
(epoxide), --N.dbd.C.dbd.O, --SO.sub.2--CH.dbd.CH.sub.2,
--N(COCH).sub.2 (i.e., a five-membered heterocyclic ring with a
double bond present between the two CH groups),
--S--S--(C.sub.5H.sub.4N), etc., where the Y groups may be the same
or different in polymer-Y.sub.n; and
[0576] where Z is the functional group resulting from the union of
a nucleophilic group (X) and an electrophilic group (Y).
[0577] As noted above, it is also contemplated by the present
invention that X and Y may be the same or different, i.e., a
synthetic polymer may have two different electrophilic groups, or
two different nucleophilic groups, such as with glutathione.
[0578] In one embodiment, the backbone of at least one of the
synthetic polymers comprises alkylene oxide residues, e.g.,
residues from ethylene oxide, propylene oxide, and mixtures
thereof. The term `backbone` refers to a significant portion of the
polymer.
[0579] For example, the synthetic polymer containing alkylene oxide
residues may be described by the formula X-polymer-X or
Y-polymer-Y, wherein X and Y are as defined above, and the term
"polymer" represents --(CH.sub.2CH.sub.2O).sub.n-- or
--(CH(CH.sub.3)CH.sub.2O).sub.n-- or
--(CH.sub.2--CH.sub.2--O).sub.n--(CH(CH.sub.3)CH.sub.2--O).sub.n--.
In these cases the synthetic polymer would be difunctional.
[0580] The required functional group X or Y is commonly coupled to
the polymer backbone by a linking group (represented below as "Q"),
many of which are known or possible. There are many ways to prepare
the various functionalized polymers, some of which are listed
below:
Polymer-Q.sub.1-X+Polymer-Q.sub.2-Y.fwdarw.Polymer-Q.sub.1-Z-Q.sub.2-Polym-
er
[0581] Exemplary Q groups include --O--(CH.sub.2).sub.n--;
--S--(CH.sub.2).sub.n--; --NH--(CH.sub.2).sub.n--;
--O.sub.2C--NH--(CH.sub.2).sub.n--; --O.sub.2C--(CH.sub.2).sub.n--;
--O.sub.2C--(CR.sup.1H).sub.n--; and --O--R.sub.2--CO--NH--, which
provide synthetic polymers of the partial structures:
polymer-O--(CH.sub.2).sub.n--(X or Y);
polymer-S--(CH.sub.2).sub.n--(X or Y);
polymer-NH--(CH.sub.2).sub.n--(X or Y);
polymer-O.sub.2C--NH--(CH.sub- .2).sub.n--(X or Y);
polymer-O.sub.2C--(CH.sub.2).sub.n--(X or Y);
polymer-O.sub.2C--(CR.sup.1H).sub.n--(X or Y); and
polymer-O--R.sub.2--CO--NH--(X or Y), respectively. In these
structures, n=1-10, R.sup.1.dbd.H or alkyl (i.e., CH.sub.3,
C.sub.2H.sub.5, etc.); R.sup.2.dbd.CH.sub.2, or
CO--NH--CH.sub.2CH.sub.2; and Q.sub.1 and Q.sub.2 may be the same
or different.
[0582] For example, when Q.sub.2.dbd.OCH.sub.2CH.sub.2 (there is no
Q.sub.1 in this case); Y.dbd.--CO.sub.2--N(COCH.sub.2).sub.2; and
X.dbd.--NH.sub.2, --SH, or --OH, the resulting reactions and Z
groups would be as follows:
Polymer-NH.sub.2+Polymer-O--CH.sub.2--CH.sub.2--CO.sub.2--N(COCH.sub.2).su-
b.2.fwdarw.Polymer-NH--CO--CH.sub.2--CH.sub.2--O-Polymer;
Polymer-SH+Polymer-O--CH.sub.2--CH.sub.2--CO.sub.2--N(COCH.sub.2).sub.2.fw-
darw.Polymer-S--COCH.sub.2CH.sub.2--O-Polymer; and
Polymer-OH+Polymer-O--CH.sub.2--CH.sub.2--CO.sub.2--N(COCH.sub.2).sub.2.fw-
darw.Polymer-O--COCH.sub.2CH.sub.2--O-Polymer.
[0583] An additional group, represented below as "D", can be
inserted between the polymer and the linking group, if present. One
purpose of such a D group is to affect the degradation rate of the
crosslinked polymer composition in vivo, for example, to increase
the degradation rate, or to decrease the degradation rate. This may
be useful in many instances, for example, when drug has been
incorporated into the matrix, and it is desired to increase or
decrease polymer degradation rate so as to influence a drug
delivery profile in the desired direction. An illustration of a
crosslinking reaction involving first and second synthetic polymers
each having D and Q groups is shown below.
Polymer-D-Q-X+Polymer-D-Q-Y.fwdarw.Polymer-D-Q-Z-Q-D-Polymer
[0584] Some useful biodegradable groups "D" include polymers formed
from one or more .alpha.-hydroxy acids, e.g., lactic acid, glycolic
acid, and the cyclization products thereof (e.g., lactide,
glycolide), E-caprolactone, and amino acids. The polymers may be
referred to as polylactide, polyglycolide,
poly(co-lactide-glycolide); poly-.epsilon.-caprolactone,
polypeptide (also known as poly amino acid, for example, various
di- or tri-peptides) and poly(anhydride)s.
[0585] In a general method for preparing the crosslinked polymer
compositions used in the context of the present invention, a first
synthetic polymer containing multiple nucleophilic groups is mixed
with a second synthetic polymer containing multiple electrophilic
groups. Formation of a three-dimensional crosslinked network occurs
as a result of the reaction between the nucleophilic groups on the
first synthetic polymer and the electrophilic groups on the second
synthetic polymer.
[0586] The concentrations of the first synthetic polymer and the
second synthetic polymer used to prepare the compositions of the
present invention will vary depending upon a number of factors,
including the types and molecular weights of the particular
synthetic polymers used and the desired end use application. In
general, when using multi-amino PEG as the first synthetic polymer,
it is preferably used at a concentration in the range of about 0.5
to about 20 percent by weight of the final composition, while the
second synthetic polymer is used at a concentration in the range of
about 0.5 to about 20 percent by weight of the final composition.
For example, a final composition having a total weight of 1 gram
(1000 milligrams) would contain between about 5 to about 200
milligrams of multi-amino PEG, and between about 5 to about 200
milligrams of the second synthetic polymer.
[0587] Use of higher concentrations of both first and second
synthetic polymers will result in the formation of a more tightly
crosslinked network, producing a stiffer, more robust gel.
Compositions intended for use in tissue augmentation will generally
employ concentrations of first and second synthetic polymer that
fall toward the higher end of the preferred concentration range.
Compositions intended for use as bioadhesives or in adhesion
prevention do not need to be as firm and may therefore contain
lower polymer concentrations.
[0588] Because polymers containing multiple electrophilic groups
will also react with water, the second synthetic polymer is
generally stored and used in sterile, dry form to prevent the loss
of crosslinking ability due to hydrolysis which typically occurs
upon exposure of such electrophilic groups to aqueous media.
Processes for preparing synthetic hydrophilic polymers containing
multiple electrophylic groups in sterile, dry form are set forth in
U.S. Pat. No. 5,643,464. For example, the dry synthetic polymer may
be compression molded into a thin sheet or membrane, which can then
be sterilized using gamma or, preferably, e-beam irradiation. The
resulting dry membrane or sheet can be cut to the desired size or
chopped into smaller size particulates. In contrast, polymers
containing multiple nucleophilic groups are generally not
water-reactive and can therefore be stored in aqueous solution.
[0589] In certain embodiments, one or both of the electrophilic- or
nucleophilic-terminated polymers described above can be combined
with a synthetic or naturally occurring polymer. The presence of
the synthetic or naturally occurring polymer may enhance the
mechanical and/or adhesive properties of the in situ forming
compositions. Naturally occurring polymers, and polymers derived
from naturally occurring polymer that may be included in in situ
forming materials include naturally occurring proteins, such as
collagen, collagen derivatives (such as methylated collagen),
fibrinogen, thrombin, albumin, fibrin, and derivatives of and
naturally occurring polysaccharides, such as glycosaminoglycans,
including deacetylated and desulfated glycosaminoglycan
derivatives.
[0590] In one aspect, a composition comprising naturally-occurring
protein and both of the first and second synthetic polymer as
described above is used to form the crosslinked matrix according to
the present invention. In one aspect, a composition comprising
collagen and both of the first and second synthetic polymer as
described above is used to form the crosslinked matrix according to
the present invention. In one aspect, a composition comprising
methylated collagen and both of the first and second synthetic
polymer as described above is used to form the crosslinked matrix
according to the present invention. In one aspect, a composition
comprising fibrinogen and both of the first and second synthetic
polymer as described above is used to form the crosslinked matrix
according to the present invention. In one aspect, a composition
comprising thrombin and both of the first and second synthetic
polymer as described above is used to form the crosslinked matrix
according to the present invention. In one aspect, a composition
comprising albumin and both of the first and second synthetic
polymer as described above is used to form the crosslinked matrix
according to the present invention. In one aspect, a composition
comprising fibrin and both of the first and second synthetic
polymer as described above is used to form the crosslinked matrix
according to the present invention. In one aspect, a composition
comprising naturally occurring polysaccharide and both of the first
and second synthetic polymer as described above is used to form the
crosslinked matrix according to the present invention. In one
aspect, a composition comprising glycosaminoglycan and both of the
first and second synthetic polymer as described above is used to
form the crosslinked matrix according to the present invention. In
one aspect, a composition comprising deacetylated glycosaminoglycan
and both of the first and second synthetic polymer as described
above is used to form the crosslinked matrix according to the
present invention. In one aspect, a composition comprising
desulfated glycosaminoglycan and both of the first and second
synthetic polymer as described above is used to form the
crosslinked matrix according to the present invention.
[0591] In one aspect, a composition comprising naturally-occurring
protein and the first synthetic polymer as described above is used
to form the crosslinked matrix according to the present invention.
In one aspect, a composition comprising collagen and the first
synthetic polymer as described above is used to form the
crosslinked matrix according to the present invention. In one
aspect, a composition comprising methylated collagen and the first
synthetic polymer as described above is used to form the
crosslinked matrix according to the present invention. In one
aspect, a composition comprising fibrinogen and the first synthetic
polymer as described above is used to form the crosslinked matrix
according to the present invention. In one aspect, a composition
comprising thrombin and the first synthetic polymer as described
above is used to form the crosslinked matrix according to the
present invention. In one aspect, a composition comprising albumin
and the first synthetic polymer as described above is used to form
the crosslinked matrix according to the present invention. In one
aspect, a composition comprising fibrin and the first synthetic
polymer as described above is used to form the crosslinked matrix
according to the present invention. In one aspect, a composition
comprising naturally occurring polysaccharide and the first
synthetic polymer as described above is used to form the
crosslinked matrix according to the present invention. In one
aspect, a composition comprising glycosaminoglycan and the first
synthetic polymer as described above is used to form the
crosslinked matrix according to the present invention. In one
aspect, a composition comprising deacetylated glycosaminoglycan and
the first synthetic polymer as described above is used to form the
crosslinked matrix according to the present invention. In one
aspect, a composition comprising desulfated glycosaminoglycan and
the first synthetic polymer as described above is used to form the
crosslinked matrix according to the present invention.
[0592] In one aspect, a composition comprising naturally-occurring
protein and the second synthetic polymer as described above is used
to form the crosslinked matrix according to the present invention.
In one aspect, a composition comprising collagen and the second
synthetic polymer as described above is used to form the
crosslinked matrix according to the present invention. In one
aspect, a composition comprising methylated collagen and the second
synthetic polymer as described above is used to form the
crosslinked matrix according to the present invention. In one
aspect, a composition comprising fibrinogen and the second
synthetic polymer as described above is used to form the
crosslinked matrix according to the present invention. In one
aspect, a composition comprising thrombin and the second synthetic
polymer as described above is used to form the crosslinked matrix
according to the present invention. In one aspect, a composition
comprising albumin and the second synthetic polymer as described
above is used to form the crosslinked matrix according to the
present invention. In one aspect, a composition comprising fibrin
and the second synthetic polymer as described above is used to form
the crosslinked matrix according to the present invention. In one
aspect, a composition comprising naturally occurring polysaccharide
and the second synthetic polymer as described above is used to form
the crosslinked matrix according to the present invention. In one
aspect, a composition comprising glycosaminoglycan and the second
synthetic polymer as described above is used to form the
crosslinked matrix according to the present invention. In one
aspect, a composition comprising deacetylated glycosaminoglycan and
the second synthetic polymer as described above is used to form the
crosslinked matrix according to the present invention. In one
aspect, a composition comprising desulfated glycosaminoglycan and
the second synthetic polymer as described above is used to form the
crosslinked matrix according to the present invention.
[0593] The presence of protein or polysaccharide components which
contain functional groups that can react with the functional groups
on multiple activated synthetic polymers can result in formation of
a crosslinked synthetic polymer-naturally occurring polymer matrix
upon mixing and/or crosslinking of the synthetic polymer(s). In
particular, when the naturally occurring polymer (protein or
polysaccharide) also contains nucleophilic groups such as primary
amino groups, the electrophilic groups on the second synthetic
polymer will react with the primary amino groups on these
components, as well as the nucleophilic groups on the first
synthetic polymer, to cause these other components to become part
of the polymer matrix. For example, lysine-rich proteins such as
collagen may be especially reactive with electrophilic groups on
synthetic polymers.
[0594] In one aspect, the naturally occurring protein is polymer
may be collagen. As used herein, the term "collagen" or "collagen
material" refers to all forms of collagen, including those which
have been processed or otherwise modified and is intended to
encompass collagen of any type, from any source, including, but not
limited to, collagen extracted from tissue or produced
recombinantly, collagen analogues, collagen derivatives, modified
collagens, and denatured collagens, such as gelatin.
[0595] In general, collagen from any source may be included in the
compositions of the invention; for example, collagen may be
extracted and purified from human or other mammalian source, such
as bovine or porcine corium and human placenta, or may be
recombinantly or otherwise produced. The preparation of purified,
substantially non-antigenic collagen in solution from bovine skin
is well known in the art. U.S. Pat. No. 5,428,022 discloses methods
of extracting and purifying collagen from the human placenta. U.S.
Pat. No. 5,667,839, discloses methods of producing recombinant
human collagen in the milk of transgenic animals, including
transgenic cows. Collagen of any type, including, but not limited
to, types I, II, III, IV, or any combination thereof, may be used
in the compositions of the invention, although type I is generally
preferred. Either atelopeptide or telopeptide-containing collagen
may be used; however, when collagen from a xenogeneic source, such
as bovine collagen, is used, atelopeptide collagen is generally
preferred, because of its reduced immunogenicity compared to
telopeptide-containing collagen.
[0596] Collagen that has not been previously crosslinked by methods
such as heat, irradiation, or chemical crosslinking agents is
preferred for use in the compositions of the invention, although
previously crosslinked collagen may be used. Non-crosslinked
atelopeptide fibrillar collagen is commercially available from
Inamed Aesthetics (Santa Barbara, Calif.) at collagen
concentrations of 35 mg/ml and 65 mg/ml under the trademarks ZYDERM
I Collagen and ZYDERM II Collagen, respectively. Glutaraidehyde
crosslinked atelopeptide fibrillar collagen is commercially
available from Inamed Corporation (Santa Barbara, Calif.) at a
collagen concentration of 35 mg/ml under the trademark ZYPLAST
Collagen.
[0597] Collagens for use in the present invention are generally in
aqueous suspension at a concentration between about 20 mg/ml to
about 120 mg/ml; preferably, between about 30 mg/ml to about 90
mg/ml.
[0598] Because of its tacky consistency, nonfibrillar collagen may
be preferred for use in compositions that are intended for use as
bioadhesives. The term "nonfibrillar collagen" refers to any
modified or unmodified collagen material that is in substantially
nonfibrillar form at pH 7, as indicated by optical clarity of an
aqueous suspension of the collagen.
[0599] Collagen that is already in nonfibrillar form may be used in
the compositions of the invention. As used herein, the term
"nonfibrillar collagen" is intended to encompass collagen types
that are nonfibrillar in native form, as well as collagens that
have been chemically modified such that they are in nonfibrillar
form at or around neutral pH. Collagen types that are nonfibrillar
(or microfibrillar) in native form include types IV, VI, and
VII.
[0600] Chemically modified collagens that are in nonfibrillar form
at neutral pH include succinylated collagen and methylated
collagen, both of which can be prepared according to the methods
described in U.S. Pat. No. 4,164,559, issued Aug. 14, 1979, to
Miyata et al., which is hereby incorporated by reference in its
entirety. Due to its inherent tackiness, methylated collagen is
particularly preferred for use in bioadhesive compositions, as
disclosed in U.S. application Ser. No. 08/476,825.
[0601] Collagens for use in the crosslinked polymer compositions of
the present invention may start out in fibrillar form, then be
rendered nonfibrillar by the addition of one or more fiber
disassembly agent. The fiber disassembly agent must be present in
an amount sufficient to render the collagen substantially
nonfibrillar at pH 7, as described above. Fiber disassembly agents
for use in the present invention include, without limitation,
various biocompatible alcohols, amino acids (e.g., arginine),
inorganic salts (e.g., sodium chloride and potassium chloride), and
carbohydrates (e.g., various sugars including sucrose).
[0602] In one aspect, the polymer may be collagen or a collagen
derivative, for example methylated collagen. An example of an in
situ forming composition uses pentaerythritol poly(ethylene
glycol)ether tetra-sulfhydryl] (4-armed thiol PEG), pentaerythritol
poly(ethylene glycol)ether tetra-succinimidyl glutarate] (4-armed
NHS PEG) and methylated collagen as the reactive reagents. This
composition, when mixed with the appropriate buffers can produce a
crosslinked hydrogel. (See, e.g., U.S. Pat. Nos. 5,874,500;
6,051,648; 6,166,130; 5,565,519 and 6,312,725).
[0603] In another aspect, the naturally occurring polymer may be a
glycosaminoglycan. Glycosaminoglycans, e.g., hyaluronic acid,
contain both anionic and cationic functional groups along each
polymeric chain, which can form intramolecular and/or
intermolecular ionic crosslinks, and are responsible for the
thixotropic (or shear thinning) nature of hyaluronic acid.
[0604] In certain aspects, the glycosaminoglycan may be
derivatized. For example, glycosaminoglycans can be chemically
derivatized by, e.g., deacetylation, desulfation, or both in order
to contain primary amino groups available for reaction with
electrophilic groups on synthetic polymer molecules.
Glycosaminoglycans that can be derivatized according to either or
both of the aforementioned methods include the following:
hyaluronic acid, chondroitin sulfate A, chondroitin sulfate B
(dermatan sulfate), chondroitin sulfate C, chitin (can be
derivatized to chitosan), keratan sulfate, keratosulfate, and
heparin. Derivatization of glycosaminoglycans by deacetylation
and/or desulfation and covalent binding of the resulting
glycosaminoglycan derivatives with synthetic hydrophilic polymers
is described in further detail in commonly assigned, allowed U.S.
patent application Ser. No. 08/146,843, filed Nov. 3, 1993.
[0605] In general, the collagen is added to the first synthetic
polymer, then the collagen and first synthetic polymer are mixed
thoroughly to achieve a homogeneous composition. The second
synthetic polymer is then added and mixed into the collagen/first
synthetic polymer mixture, where it will covalently bind to primary
amino groups or thiol groups on the first synthetic polymer and
primary amino groups on the collagen, resulting in the formation of
a homogeneous crosslinked network. Various deacetylated and/or
desulfated glycosaminoglycan derivatives can be incorporated into
the composition in a similar manner as that described above for
collagen. In addition, the introduction of hydrocolloids such as
carboxymethylcellulose may promote tissue adhesion and/or
swellability.
[0606] Administration of the Crosslinked Synthetic Polymer
Compositions
[0607] The compositions of the present invention having two
synthetic polymers may be administered before, during or after
crosslinking of the first and second synthetic polymer. Certain
uses, which are discussed in greater detail below, such as tissue
augmentation, may require the compositions to be crosslinked before
administration, whereas other applications, such as tissue
adhesion, require the compositions to be administered before
crosslinking has reached "equilibrium." The point at which
crosslinking has reached equilibrium is defined herein as the point
at which the composition no longer feels tacky or sticky to the
touch.
[0608] In order to administer the composition prior to
crosslinking, the first synthetic polymer and second synthetic
polymer may be contained within separate barrels of a
dual-compartment syringe. In this case, the two synthetic polymers
do not actually mix until the point at which the two polymers are
extruded from the tip of the syringe needle into the patient's
tissue. This allows the vast majority of the crosslinking reaction
to occur in situ, avoiding the problem of needle blockage which
commonly occurs if the two synthetic polymers are mixed too early
and crosslinking between the two components is already too advanced
prior to delivery from the syringe needle. The use of a
dual-compartment syringe, as described above, allows for the use of
smaller diameter needles, which is advantageous when performing
soft tissue augmentation in delicate facial tissue, such as that
surrounding the eyes.
[0609] Alternatively, the first synthetic polymer and second
synthetic polymer may be mixed according to the methods described
above prior to delivery to the tissue site, then injected to the
desired tissue site immediately (preferably, within about 60
seconds) following mixing.
[0610] In another embodiment of the invention, the first synthetic
polymer and second synthetic polymer are mixed, then extruded and
allowed to crosslink into a sheet or other solid form. The
crosslinked solid is then dehydrated to remove substantially all
unbound water. The resulting dried solid may be ground or
comminuted into particulates, then suspended in a nonaqueous fluid
carrier, including, without limitation, hyaluronic acid, dextran
sulfate, dextran, succinylated noncrosslinked collagen, methylated
noncrosslinked collagen, glycogen, glycerol, dextrose, maltose,
triglycerides of fatty acids (such as corn oil, soybean oil, and
sesame oil), and egg yolk phospholipid. The suspension of
particulates can be injected through a small-gauge needle to a
tissue site. Once inside the tissue, the crosslinked polymer
particulates will rehydrate and swell in size at least
five-fold.
[0611] Hydrophilic Polymer +Plurality of Crosslinkable
Components
[0612] As mentioned above, the first and/or second synthetic
polymers may be combined with a hydrophilic polymer, e.g., collagen
or methylated collagen, to form a composition useful in the present
invention. In one general embodiment, the compositions useful in
the present invention include a hydrophilic polymer in combination
with two or more crosslinkable components. This embodiment is
described in further detail in this section.
[0613] The Hydrophilic Polymer Component:
[0614] The hydrophilic polymer component may be a synthetic or
naturally occurring hydrophilic polymer. Naturally occurring
hydrophilic polymers include, but are not limited to: proteins such
as collagen and derivatives thereof, fibronectin, albumins,
globulins, fibrinogen, and fibrin, with collagen particularly
preferred; carboxylated polysaccharides such as polymannuronic acid
and polygalacturonic acid; aminated polysaccharides, particularly
the glycosaminoglycans, e.g., hyaluronic acid, chitin, chondroitin
sulfate A, B, or C, keratin sulfate, keratosulfate and heparin; and
activated polysaccharides such as dextran and starch derivatives.
Collagen (e.g., methylated collagen) and glycosaminoglycans are
preferred naturally occurring hydrophilic polymers for use
herein.
[0615] In general, collagen from any source may be used in the
composition of the method; for example, collagen may be extracted
and purified from human or other mammalian source, such as bovine
or porcine corium and human placenta, or may be recombinantly or
otherwise produced. The preparation of purified, substantially
non-antigenic collagen in solution from bovine skin is well known
in the art. See, e.g., U.S. Pat. No. 5,428,022, to Palefsky et al.,
which discloses methods of extracting and purifying collagen from
the human placenta. See also U.S. Pat. No. 5,667,839, to Berg,
which discloses methods of producing recombinant human collagen in
the milk of transgenic animals, including transgenic cows. Unless
otherwise specified, the term "collagen" or "collagen material" as
used herein refers to all forms of collagen, including those that
have been processed or otherwise modified.
[0616] Collagen of any type, including, but not limited to, types
I, II, III, IV, or any combination thereof, may be used in the
compositions of the invention, although type I is generally
preferred. Either atelopeptide or telopeptide-containing collagen
may be used; however, when collagen from a source, such as bovine
collagen, is used, atelopeptide collagen is generally preferred,
because of its reduced immunogenicity compared to
telopeptide-containing collagen.
[0617] Collagen that has not been previously crosslinked by methods
such as heat, irradiation, or chemical crosslinking agents is
preferred for use in the compositions of the invention, although
previously crosslinked collagen may be used. Non-crosslinked
atelopeptide fibrillar collagen is commercially available from
McGhan Medical Corporation (Santa Barbara, Calif.) at collagen
concentrations of 35 mg/ml and 65 mg/ml under the trademarks
ZYDERM.RTM. I Collagen and ZYDERM.RTM. II Collagen, respectively.
Glutaraldehyde-crosslinked atelopeptide fibrillar collagen is
commercially available from McGhan Medical Corporation at a
collagen concentration of 35 mg/ml under the trademark
ZYPLAST.RTM..
[0618] Collagens for use in the present invention are generally,
although not necessarily, in aqueous suspension at a concentration
between about 20 mg/ml to about 120 mg/ml, preferably between about
30 mg/ml to about 90 mg/ml.
[0619] Although intact collagen is preferred, denatured collagen,
commonly known as gelatin, can also be used in the compositions of
the invention. Gelatin may have the added benefit of being
degradable faster than collagen.
[0620] Because of its greater surface area and greater
concentration of reactive groups, nonfibrillar collagen is
generally preferred. The term "nonfibrillar collagen" refers to any
modified or unmodified collagen material that is in substantially
nonfibrillar form at pH 7, as indicated by optical clarity of an
aqueous suspension of the collagen.
[0621] Collagen that is already in nonfibrillar form may be used in
the compositions of the invention. As used herein, the term
"nonfibrillar collagen" is intended to encompass collagen types
that are nonfibrillar in native form, as well as collagens that
have been chemically modified such that they are in nonfibrillar
form at or around neutral pH. Collagen types that are nonfibrillar
(or microfibrillar) in native form include types IV, VI, and
VII.
[0622] Chemically modified collagens that are in nonfibrillar form
at neutral pH include succinylated collagen, propylated collagen,
ethylated collagen, methylated collagen, and the like, both of
which can be prepared according to the methods described in U.S.
Pat. No. 4,164,559, to Miyata et al., which is hereby incorporated
by reference in its entirety. Due to its inherent tackiness,
methylated collagen is particularly preferred, as disclosed in U.S.
Pat. No. 5,614,587 to Rhee et al.
[0623] Collagens for use in the crosslinkable compositions of the
present invention may start out in fibrillar form, then be rendered
nonfibrillar by the addition of one or more fiber disassembly
agents. The fiber disassembly agent must be present in an amount
sufficient to render the collagen substantially nonfibrillar at pH
7, as described above. Fiber disassembly agents for use in the
present invention include, without limitation, various
biocompatible alcohols, amino acids, inorganic salts, and
carbohydrates, with biocompatible alcohols being particularly
preferred. Preferred biocompatible alcohols include glycerol and
propylene glycol. Non-biocompatible alcohols, such as ethanol,
methanol, and isopropanol, are not preferred for use in the present
invention, due to their potentially deleterious effects on the body
of the patient receiving them. Preferred amino acids include
arginine. Preferred inorganic salts include sodium chloride and
potassium chloride. Although carbohydrates, such as various sugars
including sucrose, may be used in the practice of the present
invention, they are not as preferred as other types of fiber
disassembly agents because they can have cytotoxic effects in
vivo.
[0624] As fibrillar collagen has less surface area and a lower
concentration of reactive groups than nonfibrillar, fibrillar
collagen is less preferred. However, as disclosed in U.S. Pat. No.
5,614,587, fibrillar collagen, or mixtures of nonfibrillar and
fibrillar collagen, may be preferred for use in compositions
intended for long-term persistence in vivo, if optical clarity is
not a requirement.
[0625] Synthetic hydrophilic polymers may also be used in the
present invention. Useful synthetic hydrophilic polymers include,
but are not limited to: polyalkylene oxides, particularly
polyethylene glycol and poly(ethylene oxide)-poly(propylene oxide)
copolymers, including block and random copolymers; polyols such as
glycerol, polyglycerol (particularly highly branched polyglycerol),
propylene glycol and trimethylene glycol substituted with one or
more polyalkylene oxides, e.g., mono-, di- and tri-polyoxyethylated
glycerol, mono- and di-polyoxyethylated propylene glycol, and mono-
and di-polyoxyethylated trimethylene glycol; polyoxyethylated
sorbitol, polyoxyethylated glucose; acrylic acid polymers and
analogs and copolymers thereof, such as polyacrylic acid per se,
polymethacrylic acid, poly(hydroxyethyl-methacry- late),
poly(hydroxyethylacrylate), poly(methylalkylsulfoxide
methacrylate), poly(methylalkylsulfoxide acrylate) and copolymers
of any of the foregoing, and/or with additional acrylate species
such as aminoethyl acrylate and mono-2-(acryloxy)-ethy lsuccinate;
polymaleic acid; poly(acrylamides) such as polyacrylamide per se,
poly(methacrylamide), poly(dimethylacrylamide), and
poly(N-isopropyl-acrylamide); poly(olefinic alcohol)s such as
poly(vinyl alcohol); poly(N-vinyl lactams) such as poly(vinyl
pyrrolidone), poly(N-vinyl caprolactam), and copolymers thereof;
polyoxazolines, including poly(methyloxazoline) and
poly(ethyloxazoline); and polyvinylamines. It must be emphasized
that the aforementioned list of polymers is not exhaustive, and a
variety of other synthetic hydrophilic polymers may be used, as
will be appreciated by those skilled in the art.
[0626] The Crosslinkable Components:
[0627] The compositions of the invention also comprise a plurality
of crosslinkable components. Each of the crosslinkable components
participates in a reaction that results in a crosslinked matrix.
Prior to completion of the crosslinking reaction, the crosslinkable
components provide the necessary adhesive qualities that enable the
methods of the invention.
[0628] The crosslinkable components are selected so that
crosslinking gives rise to a biocompatible, nonimmunogenic matrix
useful in a variety of contexts including adhesion prevention,
biologically active agent delivery, tissue augmentation, and other
applications. The crosslinkable components of the invention
comprise: a component A, which has m nucleophilic groups, wherein
m.gtoreq.2 and a component B, which has n electrophilic groups
capable of reaction with the m nucleophilic groups, wherein
n.gtoreq.2 and m+n.gtoreq.4. An optional third component, optional
component C, which has at least one functional group that is either
electrophilic and capable of reaction with the nucleophilic groups
of component A, or nucleophilic and capable of reaction with the
electrophilic groups of component B may also be present. Thus, the
total number of functional groups present on components A, B and C,
when present, in combination is .gtoreq.5; that is, the total
functional groups given by m+n+p must be .gtoreq.5, where p is the
number of functional groups on component C and, as indicated, is
.gtoreq.1. Each of the components is biocompatible and
nonimmunogenic, and at least one component is comprised of a
hydrophilic polymer. Also, as will be appreciated, the composition
may contain additional crosslinkable components D, E, F, etc.,
having one or more reactive nucleophilic or electrophilic groups
and thereby participate in formation of the crosslinked biomaterial
via covalent bonding to other components.
[0629] The m nucleophilic groups on component A may all be the
same, or, alternatively, A may contain two or more different
nucleophilic groups. Similarly, the n electrophilic groups on
component B may all be the same, or two or more different
electrophilic groups may be present. The functional group(s) on
optional component C, if nucleophilic, may or may not be the same
as the nucleophilic groups on component A, and, conversely, if
electrophilic, the functional group(s) on optional component C may
or may not be the same as the electrophilic groups on component
B.
[0630] Accordingly, the components may be represented by the
structural formulae
30 (I) R.sup.1(--[Q.sup.1].sub.q--X).sub.m (component A), (II)
R.sup.2(--[Q.sup.2].sub.r--Y).sub.n (component B), and (III)
R.sup.3(--[Q.sup.3].sub.s--Fn).sub.p (optional component C),
[0631] wherein:
[0632] R.sup.1, R.sup.2 and R.sup.3 are independently selected from
the group consisting of C.sub.2 to C.sub.14 hydrocarbyl,
heteroatom-containing C.sub.2 to C.sub.14 hydrocarbyl, hydrophilic
polymers, and hydrophobic polymers, providing that at least one of
R.sup.1, R.sup.2 and R.sup.3 is a hydrophilic polymer, preferably a
synthetic hydrophilic polymer;
[0633] X represents one of the m nucleophilic groups of component
A, and the various X moieties on A may be the same or
different;
[0634] Y represents one of the n electrophilic groups of component
B, and the various Y moieties on A may be the same or
different;
[0635] Fn represents a functional group on optional component
C;
[0636] Q.sup.1, Q.sup.2 and Q.sup.3 are linking groups;
[0637] m.gtoreq.2, n.gtoreq.2, m+n is .gtoreq.4, q, and r are
independently zero or 1, and when optional component C is present,
p.gtoreq.1, and s is independently zero or 1.
[0638] Reactive Groups:
[0639] X may be virtually any nucleophilic group, so long as
reaction can occur with the electrophilic group Y. Analogously, Y
may be virtually any electrophilic group, so long as reaction can
take place with X. The only limitation is a practical one, in that
reaction between X and Y should be fairly rapid and take place
automatically upon admixture with an aqueous medium, without need
for heat or potentially toxic or non-biodegradable reaction
catalysts or other chemical reagents. It is also preferred although
not essential that reaction occur without need for ultraviolet or
other radiation. Ideally, the reactions between X and Y should be
complete in under 60 minutes, preferably under 30 minutes. Most
preferably, the reaction occurs in about 5 to 15 minutes or
less.
[0640] Examples of nucleophilic groups suitable as X include, but
are not limited to, --NH.sub.2, --NHR.sup.4, --N(R.sup.4).sub.2,
--SH, --OH, --COOH, --C.sub.6H.sub.4--OH, --PH.sub.2, --PHR.sup.5,
--P(R.sup.5).sub.2, --NH--NH.sub.2, --CO--NH--NH.sub.2,
--C.sub.5H.sub.4N, etc. wherein R.sup.4 and R.sup.5 are
hydrocarbyl, typically alkyl or monocyclic aryl, preferably alkyl,
and most preferably lower alkyl. Organometallic moieties are also
useful nucleophilic groups for the purposes of the invention,
particularly those that act as carbanion donors. Organometallic
nucleophiles are not, however, preferred. Examples of
organometallic moieties include: Grignard functionalities --R.sup.6
MgHal wherein R.sup.6 is a carbon atom (substituted or
unsubstituted), and Hal is halo, typically bromo, iodo or chloro,
preferably bromo; and lithium-containing functionalities, typically
alkyllithium groups; sodium-containing functionalities.
[0641] It will be appreciated by those of ordinary skill in the art
that certain nucleophilic groups must be activated with a base so
as to be capable of reaction with an electrophile. For example,
when there are nucleophilic sulfhydryl and hydroxyl groups in the
crosslinkable composition, the composition must be admixed with an
aqueous base in order to remove a proton and provide an --S.sup.--
or --O.sup.-- species to enable reaction with an electrophile.
Unless it is desirable for the base to participate in the
crosslinking reaction, a nonnucleophilic base is preferred. In some
embodiments, the base may be present as a component of a buffer
solution. Suitable bases and corresponding crosslinking reactions
are described infra.
[0642] The selection of electrophilic groups provided within the
crosslinkable composition, i.e., on component B, must be made so
that reaction is possible with the specific nucleophilic groups.
Thus, when the X moieties are amino groups, the Y groups are
selected so as to react with amino groups. Analogously, when the X
moieties are sulfhydryl moieties, the corresponding electrophilic
groups are sulfhydryl-reactive groups, and the like.
[0643] By way of example, when X is amino (generally although not
necessarily primary amino), the electrophilic groups present on Y
are amino reactive groups such as, but not limited to: (1)
carboxylic acid esters, including cyclic esters and "activated"
esters; (2) acid chloride groups (--CO--Cl); (3) anhydrides
(--(CO)--O--(CO)--R); (4) ketones and aldehydes, including
.alpha.,.beta.-unsaturated aldehydes and ketones such as
--CH.dbd.CH--CH.dbd.O and --CH.dbd.CH--C(CH.sub.3).dbd.O; (5)
halides; (6) isocyanate (--N.dbd.C.dbd.O); (7) isothiocyanate
(--N.dbd.C.dbd.S); (8) epoxides; (9) activated hydroxyl groups
(e.g., activated with conventional activating agents such as
carbonyldiimidazole or sulfonyl chloride); and (10) olefins,
including conjugated olefins, such as ethenesulfonyl
(--SO.sub.2CH.dbd.CH.sub.2) and analogous functional groups,
including acrylate (--CO.sub.2--C.dbd.CH.sub.2), methacrylate
(--CO.sub.2--C(CH.sub.3).dbd.CH.sub.2)), ethyl acrylate
(--CO.sub.2--C(CH.sub.2CH.sub.3).dbd.CH.sub.2), and ethyleneimino
(--CH.dbd.CH--C.dbd.NH). Since a carboxylic acid group per se is
not susceptible to reaction with a nucleophilic amine, components
containing carboxylic acid groups must be activated so as to be
amine-reactive. Activation may be accomplished in a variety of
ways, but often involves reaction with a suitable
hydroxyl-containing compound in the presence of a dehydrating agent
such as dicyclohexylcarbodiimide (DCC) or dicyclohexylurea (DHU).
For example, a carboxylic acid can be reacted with an
alkoxy-substituted N-hydroxy-succinimide or
N-hydroxysulfosuccinimide in the presence of DCC to form reactive
electrophilic groups, the N-hydroxysuccinimide ester and the
N-hydroxysulfosuccinimide ester, respectively. Carboxylic acids may
also be activated by reaction with an acyl halide such as an acyl
chloride (e.g., acetyl chloride), to provide a reactive anhydride
group. In a further example, a carboxylic acid may be converted to
an acid chloride group using, e.g., thionyl chloride or an acyl
chloride capable of an exchange reaction. Specific reagents and
procedures used to carry out such activation reactions will be
known to those of ordinary skill in the art and are described in
the pertinent texts and literature.
[0644] Analogously, when X is sulfhydryl, the electrophilic groups
present on Y are groups that react with a sulfhydryl moiety. Such
reactive groups include those that form thioester linkages upon
reaction with a sulfhydryl group, such as those described in PCT
Publication No. WO 00/62827 to Wallace et al. As explained in
detail therein, such "sulfhydryl reactive" groups include, but are
not limited to: mixed anhydrides; ester derivatives of phosphorus;
ester derivatives of p-nitrophenol, p-nitrothiophenol and
pentafluorophenol; esters of substituted hydroxylamines, including
N-hydroxyphthalimide esters, N-hydroxysuccinimide esters,
N-hydroxysulfosuccinimide esters, and N-hydroxyglutarimide esters;
esters of 1-hydroxybenzotriazole;
3-hydroxy-3,4-dihydro-benzotriazin-4-one;
3-hydroxy-3,4-dihydro-quinazoli- ne-4-one; carbonylimidazole
derivatives; acid chlorides; ketenes; and isocyanates. With these
sulfhydryl reactive groups, auxiliary reagents can also be used to
facilitate bond formation, e.g.,
1-ethyl-3-[3-dimethylaminopropyl]carbodiimide can be used to
facilitate coupling of sulfhydryl groups to carboxyl-containing
groups.
[0645] In addition to the sulfhydryl reactive groups that form
thioester linkages, various other sulfhydryl reactive
functionalities can be utilized that form other types of linkages.
For example, compounds that contain methyl imidate derivatives form
imido-thioester linkages with sulfhydryl groups. Alternatively,
sulfhydryl reactive groups can be employed that form disulfide
bonds with sulfhydryl groups; such groups generally have the
structure --S--S--Ar where Ar is a substituted or unsubstituted
nitrogen-containing heteroaromatic moiety or a non-heterocyclic
aromatic group substituted with an electron-withdrawing moiety,
such that Ar may be, for example, 4-pyridinyl, o-nitrophenyl,
m-nitrophenyl, p-nitrophenyl, 2,4-dinitrophenyl, 2-nitro-4-benzoic
acid, 2-nitro-4-pyridinyl, etc. In such instances, auxiliary
reagents, i.e., mild oxidizing agents such as hydrogen peroxide,
can be used to facilitate disulfide bond formation.
[0646] Yet another class of sulfhydryl reactive groups forms
thioether bonds with sulfhydryl groups. Such groups include, inter
alia, maleimido, substituted maleimido, haloalkyl, epoxy, imino,
and aziridino, as well as olefins (including conjugated olefins)
such as ethenesulfonyl, etheneimino, acrylate, methacrylate, and
.alpha.,.beta.-unsaturated aldehydes and ketones. This class of
sulfhydryl reactive groups are particularly preferred as the
thioether bonds may provide faster crosslinking and longer in vivo
stability.
[0647] When X is --OH, the electrophilic functional groups on the
remaining component(s) must react with hydroxyl groups. The
hydroxyl group may be activated as described above with respect to
carboxylic acid groups, or it may react directly in the presence of
base with a sufficiently reactive electrophile such as an epoxide
group, an aziridine group, an acyl halide, or an anhydride.
[0648] When X is an organometallic nucleophile such as a Grignard
functionality or an alkyllithium group, suitable electrophilic
functional groups for reaction therewith are those containing
carbonyl groups, including, by way of example, ketones and
aldehydes.
[0649] It will also be appreciated that certain functional groups
can react as nucleophiles or as electrophiles, depending on the
selected reaction partner and/or the reaction conditions. For
example, a carboxylic acid group can act as a nucleophile in the
presence of a fairly strong base, but generally acts as an
electrophile allowing nucleophilic attack at the carbonyl carbon
and concomitant replacement of the hydroxyl group with the incoming
nucleophile.
[0650] The covalent linkages in the crosslinked structure that
result upon covalent binding of specific nucleophilic components to
specific electrophilic components in the crosslinkable composition
include, solely by way of example, the following (the optional
linking groups Q.sup.1 and Q.sup.2 are omitted for clarity):
31TAABLE REPRESENTATIVE NUCLEOPHILIC COMPONENT REPRESENTATIVE (A,
optional ELECTROPHILIC component C COMPONENT element FN.sub.NU) (B,
FN.sub.EL) RESULTING LINKAGE R.sup.1-NH.sub.2
R.sup.2-O--(CO)--O--N(COCH.sub.2) R.sup.1-N--(CO)--O-R.sup.2
(succinimidyl carbonate terminus) R.sup.1-SH
R.sup.2-O--(CO)--O--N(COCH.sub.2) R.sup.1-S--(CO)--O-R.sup.2
R.sup.1-OH R.sup.2-O--(CO)--O--N(COCH.s- ub.2)
R.sup.1-O--(CO)-R.sup.2 R.sup.1-NH.sub.2
R.sup.2-O(CO)--CH.dbd.CH.sub.2
R.sup.1-NH--CH.sub.2CH.sub.2--(CO)--O-R.su- p.2 (acrylate terminus)
R.sup.1-SH R.sup.2-O--(CO)--CH.dbd.- CH.sub.2
R.sup.1-S--CH.sub.2CH.sub.2--(CO)--O-R.sup.2 R.sup.1-OH
R.sup.2-O--(CO)--CH.dbd.CH.sub.2
R.sup.1-O--CH.sub.2CH.sub.2--(CO)--O-R.s- up.2 R.sup.1-NH.sub.2
R.sup.2-O(CO)--(CH.sub.2).sub.3--CO.sub.2--N(- COCH.sub.2)
R.sup.1-NH--(CO)--(CH.sub.2).sub.3--(CO)--OR.sup.2 (succinimidyl
glutarate terminus) R.sup.1-SH
R.sup.2-O(CO)--(CH.sub.2).sub.3--CO.sub.2--N(COCH.sub.2)
R.sup.1-S--(CO)--(CH.sub.2).sub.3--(CO)--OR.sup.2 R.sup.1-OH
R.sup.2-O(CO)--(CH.sub.2).sub.3--CO.sub.2--N(COCH.sub.2)
R.sup.1-O--(CO)--(CH.sub.2).sub.3--(CO)--OR.sup.2 R.sup.1-NH.sub.2
R.sup.2-O--CH.sub.2--CO.sub.2--N(COCH.sub.2)
R.sup.1-NH--(CO)--CH.sub.2--- OR.sup.2 (succinimidyl acetate
terminus) R.sup.1-SH R.sup.2-O--CH.sub.2--CO.sub.2--N(COCH.sub.2)
R.sup.1-S--(CO)--CH.sub.2--O- R.sup.2 R.sup.1-OH
R.sup.2-O--CH.sub.2--CO.sub.2--N(COCH.sub.2)
R.sup.1-O--(CO)--CH.sub.2--OR.sup.2 R.sup.1-NH.sub.2
R.sup.2-O--NH(CO)--(CH.sub.2).sub.2--CO.sub.2--N(COCH.sub.2)
R.sup.1-S--(CO)--(CH.sub.2).sub.2--(CO)--NH--OR.sup.2 R.sup.1-OH
R.sup.2-O--NH(CO)--(CH.sub.2).sub.2--CO.sub.2--N(COCH.sub.2)
R.sup.1-O--(CO)--(CH.sub.2).sub.2--(CO)--NH--OR.sup.23
R.sup.1-NH.sub.2 R.sup.2-O--(CH.sub.2).sub.2--CHO
R.sup.1-NH--(CO)--(CH.s- ub.2).sub.2--OR.sup.2 (propionaldehyde
terminus) R.sup.1-NH.sub.2 114
R.sup.1-NH--CH.sub.2--CH(OH)--CH.sub.2--OR.sup.2 and
R.sup.1N[CH.sub.2--CH(OH)--CH.sub.2--OR.sup.2].sub.2
R.sup.1-NH.sub.2 R.sup.2-O--(CH.sub.2).sub.2--N.dbd.C.dbd.O
R.sup.1NH--(CO)--NH--CH.sub.2--OR.sup.2 (isocyanate terminus)
R.sup.1--NH.sub.2 R.sup.2-SO.sub.2--CH.dbd.CH.sub.2
R.sup.1-NH--CH.sub.2CH.sub.2--SO.sub.2-R.sup.2 (vinyl sulfone
terminus) R.sup.1-SH R.sup.2-SO.sub.2--CH.dbd.CH.sub.2
R.sup.1-S--CH.sub.2CH.sub.2--SO.sub.2-R.sup.2
[0651] Linking Groups:
[0652] The functional groups X and Y and FN on optional component C
may be directly attached to the compound core (R.sub.1, R.sup.2 or
R.sup.3 on optional component C, respectively), or they may be
indirectly attached through a linking group, with longer linking
groups also termed "chain extenders." In structural formulae (I),
(II) and (III), the optional linking groups are represented by
Q.sup.1, Q.sup.2 and Q.sup.3, wherein the linking groups are
present when q, r and s are equal to 1 (with R, X, Y, Fn, m n and p
as defined previously).
[0653] Suitable linking groups are well known in the art. See, for
example, International Patent Publication No. WO 97/22371. Linking
groups are useful to avoid steric hindrance problems that are
sometimes associated with the formation of direct linkages between
molecules. Linking groups may additionally be used to link several
multifunctionally activated compounds together to make larger
molecules. In a preferred embodiment, a linking group can be used
to alter the degradative properties of the compositions after
administration and resultant gel formation. For example, linking
groups can be incorporated into components A, B, or optional
component C to promote hydrolysis, to discourage hydrolysis, or to
provide a site for enzymatic degradation.
[0654] Examples of linking groups that provide hydrolyzable sites,
include, inter alia: ester linkages; anhydride linkages, such as
obtained by incorporation of glutarate and succinate; ortho ester
linkages; ortho carbonate linkages such as trimethylene carbonate;
amide linkages; phosphoester linkages; .alpha.-hydroxy acid
linkages, such as may be obtained by incorporation of lactic acid
and glycolic acid; lactone-based linkages, such as may be obtained
by incorporation of caprolactone, valerolactone,
.gamma.-butyrolactone and p-dioxanone; and amide linkages such as
in a dimeric, oligomeric, or poly(amino acid) segment. Examples of
non-degradable linking groups include succinimide, propionic acid
and carboxymethylate linkages. See, for example, PCT WO 99/07417.
Examples of enzymatically degradable linkages include
Leu-Gly-Pro-Ala, which is degraded by collagenase; and Gly-Pro-Lys,
which is degraded by plasmin.
[0655] Linking groups can also enhance or suppress the reactivity
of the various nucleophilic and electrophilic groups. For example,
electron-withdrawing groups within one or two carbons of a
sulfhydryl group would be expected to diminish its effectiveness in
coupling, due to a lowering of nucleophilicity. Carbon-carbon
double bonds and carbonyl groups will also have such an effect.
Conversely, electron-withdrawing groups adjacent to a carbonyl
group (e.g., the reactive carbonyl of
glutaryl-N-hydroxysuccinimidyl) would increase the reactivity of
the carbonyl carbon with respect to an incoming nucleophile. By
contrast, sterically bulky groups in the vicinity of a functional
group can be used to diminish reactivity and thus coupling rate as
a result of steric hindrance.
[0656] By way of example, particular linking groups and
corresponding component structure are indicated in the following
Table:
32TABLE LINKING GROUP COMPONENT STRUCTURE --O--(CH.sub.2).sub.n--
Component A: R.sup.1--O--(CH.sub.2).sub.n--X Component B:
R.sup.2--O--(CH.sub.2).sub.n--Y Optional Component C:
R.sup.3--O--(CH.sub.2).sub.n--Z --S--(CH.sub.2).sub.n-- Component
A: R.sup.1--S--(CH.sub.2).sub.n--X Component B:
R.sup.2--S--(CH.sub.2).sub.n--Y Optional Component C:
R.sup.3--S--(CH.sub.2).sub.n--Z --NH--(CH.sub.2).sub.n-- Component
A: R.sup.1--NH--(CH.sub.2).sub.n--X Component B:
R.sup.2--NH--(CH.sub.2).sub.n--Y Optional Component C:
R.sup.3--NH--(CH.sub.2).sub.n--Z --O--(CO)--NH--(CH.sub.2).sub.n--
Component A: R.sup.1--O--(CO)--NH--(CH.- sub.2).sub.n--X Component
B: R.sup.2--O--(CO)--NH--(CH.sub.2).sub.- n--Y Optional Component
C: R.sup.3--O--(CO)--NH--(CH.sub.2).sub.n-- -Z
--NH--(CO)--O--(CH.sub.2).sub.n-- Component A:
R.sup.1--NH--(CO)--O--(CH.sub.2).sub.n--X Component B:
R.sup.2--NH--(CO)--O--(CH.sub.2).sub.n--Y Optional Component C:
R.sup.3--NH--(CO)--O--(CH.sub.2).sub.n--Z --O--(CO)--(CH.sub.2).su-
b.n-- Component A: R.sup.1--O--(CO)--(CH.sub.2).sub.n--X Component
B: R.sup.2--O--(CO)--(CH.sub.2).sub.n--Y Optional Component C:
R.sup.3--O--(CO)--(CH.sub.2).sub.n--Z --(CO)--O--(CH.sub.2).sub.n--
- Component A: R.sup.1--(CO)--O--(CH.sub.2).sub.n--X Component B:
R.sup.2--(CO)--O--(CH.sub.2).sub.n--Y Optional Component C:
R.sup.3--(CO)--O--(CH.sub.2).sub.n--Z --O--(CO)--O--(CH.sub.2).sub-
.n-- Component A: R.sup.1--O--(CO)--O--(CH.sub.2).sub.n--X
Component B: R.sup.2--O--(CO)--O--(CH.sub.2).sub.n--Y Optional
Component C: R.sup.3--O--(CO)--O--(CH.sub.2).sub.n--Z
--O--(CO)--CHR.sup.7-- Component A: R.sup.1--O--(CO)--CHR.sup.7--X
Component B: R.sup.2--O--(CO)--CHR.sup.7--Y Optional Component C:
R.sup.3--O--(CO)--CHR.sup.7--Z --O--R.sup.8--(CO)--NH-- Component
A: R.sup.1--O--R.sup.8--(CO)--NH--X Component B:
R.sup.2--O--R.sup.8--(CO)--NH--Y Optional Component C:
R.sup.3--O--R.sup.8--(CO)--NH--Z
[0657] In the above Table, n is generally in the range of 1 to
about 10, R.sup.7 is generally hydrocarbyl, typically alkyl or
aryl, preferably alkyl, and most preferably lower alkyl, and
R.sup.8 is hydrocarbylene, heteroatom-containing hydrocarbylene,
substituted hydrocarbylene, or substituted heteroatom-containing
hydrocarbylene) typically alkylene or arylene (again, optionally
substituted and/or containing a heteroatom), preferably lower
alkylene (e.g., methylene, ethylene, n-propylene, n-butylene,
etc.), phenylene, or amidoalkylene (e.g.,
--(CO)--NH--CH.sub.2).
[0658] Other general principles that should be considered with
respect to linking groups are as follows: If higher molecular
weight components are to be used, they preferably have
biodegradable linkages as described above, so that fragments larger
than 20,000 mol. wt. are not generated during resorption in the
body. In addition, to promote water miscibility and/or solubility,
it may be desired to add sufficient electric charge or
hydrophilicity. Hydrophilic groups can be easily introduced using
known chemical synthesis, so long as they do not give rise to
unwanted swelling or an undesirable decrease in compressive
strength. In particular, polyalkoxy segments may weaken gel
strength.
[0659] The Component Core:
[0660] The "core" of each crosslinkable component is comprised of
the molecular structure to which the nucleophilic or electrophilic
groups are bound. Using the formulae (I)
R.sup.1-[Q.sup.1].sub.q-X).sub.m, for component A, (II)
R.sup.2(-[Q.sup.2].sub.r-Y).sub.n for component B, and (III)
[0661] R.sup.3(-[Q.sup.3].sub.s-Fn).sub.p for optional component C,
the "core" groups are R.sup.1, R.sup.2 and R.sup.3. Each molecular
core of the reactive components of the crosslinkable composition is
generally selected from synthetic and naturally occurring
hydrophilic polymers, hydrophobic polymers, and C.sub.2-C.sub.14
hydrocarbyl groups zero to 2 heteroatoms selected from N, O and S,
with the proviso that at least one of the crosslinkable components
A, B, and optionally C, comprises a molecular core of a synthetic
hydrophilic polymer. In a preferred embodiment, at least one of A
and B comprises a molecular core of a synthetic hydrophilic
polymer.
[0662] Hydrophilic Crosslinkable Components
[0663] In one aspect, the crosslinkable component(s) is (are)
hydrophilic polymers. The term "hydrophilic polymer" as used herein
refers to a synthetic polymer having an average molecular weight
and composition effective to render the polymer "hydrophilic" as
defined above. As discussed above, synthetic crosslinkable
hydrophilic polymers useful herein include, but are not limited to:
polyalkylene oxides, particularly polyethylene glycol and
poly(ethylene oxide)-poly(propylene oxide) copolymers, including
block and random copolymers; polyols such as glycerol, polyglycerol
(particularly highly branched polyglycerol), propylene glycol and
trimethylene glycol substituted with one or more polyalkylene
oxides, e.g., mono-, di- and tri-polyoxyethylated glycerol, mono-
and di-polyoxyethylated propylene glycol, and mono- and
di-polyoxyethylated trimethylene glycol; polyoxyethylated sorbitol,
polyoxyethylated glucose; acrylic acid polymers and analogs and
copolymers thereof, such as polyacrylic acid per se,
polymethacrylic acid, poly(hydroxyethyl-methacrylate),
poly(hydroxyethylacrylate), poly(methylalkylsulfoxide
methacrylate), poly(methylalkylsulfoxide acrylate) and copolymers
of any of the foregoing, and/or with additional acrylate species
such as aminoethyl acrylate and mono-2-(acryloxy)-ethyl succinate;
polymaleic acid; poly(acrylamides) such as polyacrylamide per se,
poly(methacrylamide), poly(dimethylacrylamide), and
poly(N-isopropyl-acrylamide); poly(olefinic alcohol)s such as
poly(vinyl alcohol); poly(N-vinyl lactams) such as poly(vinyl
pyrrolidone), poly(N-vinyl caprolactam), and copolymers thereof;
polyoxazolines, including poly(methyloxazoline) and
poly(ethyloxazoline); and polyvinylamines. It must be emphasized
that the aforementioned list of polymers is not exhaustive, and a
variety of other synthetic hydrophilic polymers may be used, as
will be appreciated by those skilled in the art.
[0664] The synthetic crosslinkable hydrophilic polymer may be a
homopolymer, a block copolymer, a random copolymer, or a graft
copolymer. In addition, the polymer may be linear or branched, and
if branched, may be minimally to highly branched, dendrimeric,
hyperbranched, or a star polymer. The polymer may include
biodegradable segments and blocks, either distributed throughout
the polymer's molecular structure or present as a single block, as
in a block copolymer. Biodegradable segments are those that degrade
so as to break covalent bonds. Typically, biodegradable segments
are segments that are hydrolyzed in the presence of water and/or
enzymatically cleaved in situ. Biodegradable segments may be
composed of small molecular segments such as ester linkages,
anhydride linkages, ortho ester linkages, ortho carbonate linkages,
amide linkages, phosphonate linkages, etc. Larger biodegradable
"blocks" will generally be composed of oligomeric or polymeric
segments incorporated within the hydrophilic polymer. Illustrative
oligomeric and polymeric segments that are biodegradable include,
by way of example, poly(amino acid) segments, poly(orthoester)
segments, poly(orthocarbonate) segments, and the like.
[0665] Other suitable synthetic crosslinkable hydrophilic polymers
include chemically synthesized polypeptides, particularly
polynucleophilic polypeptides that have been synthesized to
incorporate amino acids containing primary amino groups (such as
lysine) and/or amino acids containing thiol groups (such as
cysteine). Poly(lysine), a synthetically produced polymer of the
amino acid lysine (145 MW), is particularly preferred.
Poly(lysine)s have been prepared having anywhere from 6 to about
4,000 primary amino groups, corresponding to molecular weights of
about 870 to about 580,000. Poly(lysine)s for use in the present
invention preferably have a molecular weight within the range of
about 1,000 to about 300,000, more preferably within the range of
about 5,000 to about 100,000, and most preferably, within the range
of about 8,000 to about 15,000. Poly(lysine)s of varying molecular
weights are commercially available from Peninsula Laboratories,
Inc. (Belmont, Calif.).
[0666] The synthetic crosslinkable hydrophilic polymer may be a
homopolymer, a block copolymer, a random copolymer, or a graft
copolymer. In addition, the polymer may be linear or branched, and
if branched, may be minimally to highly branched, dendrimeric,
hyperbranched, or a star polymer. The polymer may include
biodegradable segments and blocks, either distributed throughout
the polymer's molecular structure or present as a single block, as
in a block copolymer. Biodegradable segments are those that degrade
so as to break covalent bonds. Typically, biodegradable segments
are segments that are hydrolyzed in the presence of water and/or
enzymatically cleaved in situ. Biodegradable segments may be
composed of small molecular segments such as ester linkages,
anhydride linkages, ortho ester linkages, ortho carbonate linkages,
amide linkages, phosphonate linkages, etc. Larger biodegradable
"blocks" will generally be composed of oligomeric or polymeric
segments incorporated within the hydrophilic polymer. Illustrative
oligomeric and polymeric segments that are biodegradable include,
by way of example, poly(amino acid) segments, poly(orthoester)
segments, poly(orthocarbonate) segments, and the like.
[0667] Although a variety of different synthetic crosslinkable
hydrophilic polymers can be used in the present compositions, as
indicated above, preferred synthetic crosslinkable hydrophilic
polymers are polyethylene glycol (PEG) and polyglycerol (PG),
particularly highly branched polyglycerol. Various forms of PEG are
extensively used in the modification of biologically active
molecules because PEG lacks toxicity, antigenicity, and
immunogenicity (i.e., is biocompatible), can be formulated so as to
have a wide range of solubilities, and do not typically interfere
with the enzymatic activities and/or conformations of peptides. A
particularly preferred synthetic crosslinkable hydrophilic polymer
for certain applications is a polyethylene glycol (PEG) having a
molecular weight within the range of about 100 to about 100,000
mol. wt., although for highly branched PEG, far higher molecular
weight polymers can be employed--up to 1,000,000 or more--providing
that biodegradable sites are incorporated ensuring that all
degradation products will have a molecular weight of less than
about 30,000. For most PEGs, however, the preferred molecular
weight is about 1,000 to about 20,000 mol. wt., more preferably
within the range of about 7,500 to about 20,000 mol. wt. Most
preferably, the polyethylene glycol has a molecular weight of
approximately 10,000 mol. wt.
[0668] Naturally occurring crosslinkable hydrophilic polymers
include, but are not limited to: proteins such as collagen,
fibronectin, albumins, globulins, fibrinogen, and fibrin, with
collagen particularly preferred; carboxylated polysaccharides such
as polymannuronic acid and polygalacturonic acid; aminated
polysaccharides, particularly the glycosaminoglycans, e.g.,
hyaluronic acid, chitin, chondroitin sulfate A, B, or C, keratin
sulfate, keratosulfate and heparin; and activated polysaccharides
such as dextran and starch derivatives. Collagen and
glycosaminoglycans are examples of naturally occurring hydrophilic
polymers for use herein, with methylated collagen being a preferred
hydrophilic polymer.
[0669] Any of the hydrophilic polymers herein must contain, or be
activated to contain, functional groups, i.e., nucleophilic or
electrophilic groups, which enable crosslinking. Activation of PEG
is discussed below; it is to be understood, however, that the
following discussion is for purposes of illustration and analogous
techniques may be employed with other polymers.
[0670] With respect to PEG, first of all, various functionalized
polyethylene glycols have been used effectively in fields such as
protein modification (see Abuchowski et al., Enzymes as Drugs, John
Wiley & Sons: New York, N.Y. (1981) pp. 367-383; and Dreborg et
al., Crit. Rev. Therap. Drug Carrier Syst. (1990) 6:315), peptide
chemistry (see Mutter et al., The Peptides, Academic: New York,
N.Y. 2:285-332; and Zalipsky et al., Int. J. Peptide Protein Res.
(1987) 30:740), and the synthesis of polymeric drugs (see Zalipsky
et al., Eur. Polym. J. (1983) 19:1177; and Ouchi et al., J.
Macromol. Sci. Chem. (1987) A24:1011).
[0671] Activated forms of PEG, including multifunctionally
activated PEG, are commercially available, and are also easily
prepared using known methods. For example, see Chapter 22 of
Poly(ethylene Glycol) Chemistry: Biotechnical and Biomedical
Applications, J. Milton Harris, ed., Plenum Press, NY (1992); and
Shearwater Polymers, Inc. Catalog, Polyethylene Glycol Derivatives,
Huntsville, Ala. (1997-1998).
[0672] Structures for some specific, tetrafunctionally activated
forms of PEG are shown in FIGS. 1 to 10 of U.S. Pat. No. 5,874,500,
as are generalized reaction products obtained by reacting the
activated PEGs with multi-amino PEGs, i.e., a PEG with two or more
primary amino groups. The activated PEGs illustrated have a
pentaerythritol(2,2-bis(hydroxymeth- yl)-1,3-propanediol) core.
Such activated PEGs, as will be appreciated by those in the art,
are readily prepared by conversion of the exposed hydroxyl groups
in the PEGylated polyol (i.e., the terminal hydroxyl groups on the
PEG chains) to carboxylic acid groups (typically by reaction with
an anhydride in the presence of a nitrogenous base), followed by
esterification with N-hydroxysuccinimide,
N-hydroxysulfosuccinimide, or the like, to give the
polyfunctionally activated PEG.
[0673] Hydrophobic Polymers:
[0674] The crosslinkable compositions of the invention can also
include hydrophobic polymers, although for most uses hydrophilic
polymers are preferred. Polylactic acid and polyglycolic acid are
examples of two hydrophobic polymers that can be used. With other
hydrophobic polymers, only short-chain oligomers should be used,
containing at most about 14 carbon atoms, to avoid
solubility-related problems during reaction.
[0675] Low Molecular Weight Components:
[0676] As indicated above, the molecular core of one or more of the
crosslinkable components can also be a low molecular weight
compound, i.e., a C.sub.2-C.sub.14 hydrocarbyl group containing
zero to 2 heteroatoms selected from N, O, S and combinations
thereof. Such a molecular core can be substituted with nucleophilic
groups or with electrophilic groups.
[0677] When the low molecular weight molecular core is substituted
with primary amino groups, the component may be, for example,
ethylenediamine(H.sub.2N--CH.sub.2CH.sub.2--NH.sub.2),
tetramethylenediamine(H.sub.2N--(CH.sub.4)--NH.sub.2),
pentamethylenediamine(cadaverine)(H.sub.2N--(CH.sub.5)--NH.sub.2),
hexamethylenediamine(H.sub.2N--(CH.sub.6)--NH.sub.2),
bis(2-aminoethyl)amine (HN--[CH.sub.2CH.sub.2--NH.sub.2].sub.2), or
tris(2-aminoethyl)amine(N--[CH.sub.2CH.sub.2--NH.sub.2].sub.3).
[0678] Low molecular weight diols and polyols include
trimethylolpropane, di(trimethylol propane), pentaerythritol, and
diglycerol, all of which require activation with a base in order to
facilitate their reaction as nucleophiles. Such diols and polyols
may also be functionalized to provide di- and poly-carboxylic
acids, functional groups that are, as noted earlier herein, also
useful as nucleophiles under certain conditions. Polyacids for use
in the present compositions include, without limitation,
trimethylolpropane-based tricarboxylic acid, di(trimethylol
propane)-based tetracarboxylic acid, heptanedioic acid, octanedioic
acid (suberic acid), and hexadecanedioic acid (thapsic acid), all
of which are commercially available and/or readily synthesized
using known techniques.
[0679] Low molecular weight di- and poly-electrophiles include, for
example, disuccinimidyl suberate (DSS), bis(sulfosuccinimidyl)
suberate (BS.sub.3), dithiobis(succinimidylpropionate) (DSP),
bis(2-succinimidooxycarbonyloxy)ethyl sulfone (BSOCOES), and
3,3'-dithiobis(sulfosuccinimidylpropionate (DTSPP), and their
analogs and derivatives. The aforementioned compounds are
commercially available from Pierce (Rockford, Ill.). Such di- and
poly-electrophiles can also be synthesized from di- and polyacids,
for example by reaction with an appropriate molar amount of
N-hydroxysuccinimide in the presence of DCC. Polyols such as
trimethylolpropane and di(trimethylol propane) can be converted to
carboxylic acid form using various known techniques, then further
derivatized by reaction with NHS in the presence of DCC to produce
trifunctionally and tetrafunctionally activated polymers.
[0680] Delivery Systems:
[0681] Suitable delivery systems for the homogeneous dry powder
composition (containing at least two crosslinkable polymers) and
the two buffer solutions may involve a multi-compartment spray
device, where one or more compartments contains the powder and one
or more compartments contain the buffer solutions needed to provide
for the aqueous environment, so that the composition is exposed to
the aqueous environment as it leaves the compartment. Many devices
that are adapted for delivery of multi-component tissue
sealants/hemostatic agents are well known in the art and can also
be used in the practice of the present invention. Alternatively,
the composition can be delivered using any type of controllable
extrusion system, or it can be delivered manually in the form of a
dry powder, and exposed to the aqueous environment at the site of
administration.
[0682] The homogeneous dry powder composition and the two buffer
solutions may be conveniently formed under aseptic conditions by
placing each of the three ingredients (dry powder, acidic buffer
solution and basic buffer solution) into separate syringe barrels.
For example, the composition, first buffer solution and second
buffer solution can be housed separately in a multiple-compartment
syringe system having a multiple barrels, a mixing head, and an
exit orifice. The first buffer solution can be added to the barrel
housing the composition to dissolve the composition and form a
homogeneous solution, which is then extruded into the mixing head.
The second buffer solution can be simultaneously extruded into the
mixing head. Finally, the resulting composition can then be
extruded through the orifice onto a surface.
[0683] For example, the syringe barrels holding the dry powder and
the basic buffer may be part of a dual-syringe system, e.g., a
double barrel syringe as described in U.S. Pat. 4,359,049 to Redl
et al. In this embodiment, the acid buffer can be added to the
syringe barrel that also holds the dry powder, so as to produce the
homogeneous solution. In other words, the acid buffer may be added
(e.g., injected) into the syringe barrel holding the dry powder to
thereby produce a homogeneous solution of the first and second
components. This homogeneous solution can then be extruded into a
mixing head, while the basic buffer is simultaneously extruded into
the mixing head. Within the mixing head, the homogeneous solution
and the basic buffer are mixed together-to thereby form a reactive
mixture. Thereafter, the reactive mixture is extruded through an
orifice and onto a surface (e.g., tissue), where a film is formed,
which can function as a sealant or a barrier, or the like. The
reactive mixture begins forming a three-dimensional matrix
immediately upon being formed by the mixing of the homogeneous
solution and the basic buffer in the mixing head. Accordingly, the
reactive mixture is preferably extruded from the mixing head onto
the tissue very quickly after it is formed so that the
three-dimensional matrix forms on, and is able to adhere to, the
tissue.
[0684] Other systems for combining two reactive liquids are well
known in the art, and include the systems described in U.S. Pat.
No. 6,454,786 to Holm et al.; U.S. Pat. No. 6,461,325 to Delmotte
et al.; U.S. Pat. No. 5,585,007 to Antanavich et al.; U.S. Pat. No.
5,116,315 to Capozzi et al.; and U.S. Pat. No. 4,631,055 to Redl et
al.
[0685] Storage and Handling:
[0686] Because crosslinkable components containing electrophilic
groups react with water, the electrophilic component or components
are generally stored and used in sterile, dry form to prevent
hydrolysis. Processes for preparing synthetic hydrophilic polymers
containing multiple electrophilic groups in sterile, dry form are
set forth in commonly assigned U.S. Pat. No. 5,643,464 to Rhee et
al. For example, the dry synthetic polymer may be compression
molded into a thin sheet or membrane, which can then be sterilized
using gamma or, preferably, e-beam irradiation. The resulting dry
membrane or sheet can be cut to the desired size or chopped into
smaller size particulates.
[0687] Components containing multiple nucleophilic groups are
generally not water-reactive and can therefore be stored either dry
or in aqueous solution. If stored as a dry, particulate, solid, the
various components of the crosslinkable composition may be blended
and stored in a single container. Admixture of all components with
water, saline, or other aqueous media should not occur until
immediately prior to use.
[0688] In an alternative embodiment, the crosslinking components
can be mixed together in a single aqueous medium in which they are
both unreactive, i.e., such as in a low pH buffer. Thereafter, they
can be sprayed onto the targeted tissue site along with a high pH
buffer, after which they will rapidly react and form a gel.
[0689] Suitable liquid media for storage of crosslinkable
compositions include aqueous buffer solutions such as monobasic
sodium phosphate/dibasic sodium phosphate, sodium carbonate/sodium
bicarbonate, glutamate or acetate, at a concentration of 0.5 to 300
mM. In general, a sulfhydryl-reactive component such as PEG
substituted with maleimido groups or succinimidyl esters is
prepared in water or a dilute buffer, with a pH of between around 5
to 6. Buffers with pKs between about 8 and 10.5 for preparing a
polysulfhydryl component such as sulfhydryl-PEG are useful to
achieve fast gelation time of compositions containing mixtures of
sulfhydryl-PEG and SG-PEG. These include carbonate, borate and
AMPSO
(3-[(1,1-dimethyl-2-hydroxyethyl)amino]2-hydroxy-propane-sulfonic
acid). In contrast, using a combination of maleimidyl PEG and
sulfhydryl-PEG, a pH of around 5 to 9 is preferred for the liquid
medium used to prepare the sulfhydryl PEG.
[0690] Collagen+Fibrinogen and/or Thrombin (e.g., Costasis)
[0691] In yet another aspect, the polymer composition may include
collagen in combination with fibrinogen and/or thrombin. (See,
e.g., U.S. Pat. Nos. 5,290,552; 6,096,309; and 5,997,811). For
example, an aqueous composition may include a fibrinogen and FXIII,
particularly plasma, collagen in an amount sufficient to thicken
the composition, thrombin in an amount sufficient to catalyze
polymerization of fibrinogen present in the composition, and
Ca.sup.2+ and, optionally, an antifibrinolytic agent in amount
sufficient to retard degradation of the resulting adhesive clot.
The composition may be formulated as a two-part composition that
may be mixed together just prior to use, in which fibrinogen/FXIII
and collagen constitute the first component, and thrombin together
with an antifibrinolytic agent, and Ca.sup.2+ constitute the second
component.
[0692] Plasma, which provides a source of fibrinogen, may be
obtained from the patient for which the composition is to be
delivered. The plasma can be used "as is" after standard
preparation which includes centrifuging out cellular components of
blood. Alternatively, the plasma can be further processed to
concentrate the fibrinogen to prepare a plasma cryoprecipitate. The
plasma cryoprecipitate can be prepared by freezing the plasma for
at least about an hour at about -20.degree. C., and then storing
the frozen plasma overnight at about 4.degree. C. to slowly thaw.
The thawed plasma is centrifuged and the plasma cryoprecipitate is
harvested by removing approximately four-fifths of the plasma to
provide a cryoprecipitate comprising the remaining one-fifth of the
plasma. Other fibrinogen/FXIII preparations may be used, such as
cryoprecipitate, patient autologous fibrin sealant, fibrinogen
analogs or other single donor or commercial fibrin sealant
materials. Approximately 0.5 ml to about 1.0 ml of either the
plasma or the plasma-cryoprecipitate provides about 1 to 2 ml of
adhesive composition which is sufficient for use in middle ear
surgery. Other plasma proteins (e.g., albumin, plasminogen, von
Willebrands factor, Factor VIII, etc.) may or may not be present in
the fibrinogen/FXII separation due to wide variations in the
formulations and methods to derive them.
[0693] Collagen, preferably hypoallergenic collagen, is present in
the composition in an amount sufficient to thicken the composition
and augment the cohesive properties of the preparation. The
collagen may be atelopeptide collagen or telopeptide collagen,
e.g., native collagen. In addition to thickening the composition,
the collagen augments the fibrin by acting as a macromolecular
lattice work or scaffold to which the fibrin network adsorbs. This
gives more strength and durability to the resulting glue clot with
a relatively low concentration of fibrinogen in comparison to the
various concentrated autogenous fibrinogen glue formulations (i.e.,
AFGs).
[0694] The form of collagen which is employed may be described as
at least "near native" in its structural characteristics. It may be
further characterized as resulting in insoluble fibers at a pH
above 5; unless crosslinked or as part of a complex composition,
e.g., bone, it will generally consist of a minor amount by weight
of fibers with diameters greater than 50 nm, usually from about 1
to 25 volume % and there will be substantially little, if any,
change in the helical structure of the fibrils. In addition, the
collagen composition must be able to enhance gelation in the
surgical adhesion composition.
[0695] A number of commercially available collagen preparations may
be used. ZYDERM Collagen Implant (ZCI) has a fibrillar diameter
distribution consisting of 5 to 10 nm diameter fibers at 90% volume
content and the remaining 10% with greater than about 50 nm
diameter fibers. ZCl is available as a fibrillar slurry and
solution in phosphate buffered isotonic saline, pH 7.2, and is
injectable with fine gauge needles. As distinct from ZCl,
cross-linked collagen available as ZYPLAST may be employed. ZYPLAST
is essentially an exogenously crosslinked (glutaraldehyde) version
of ZCl. The material has a somewhat higher content of greater than
about 50 nm diameter fibrils and remains insoluble over a wide pH
range. Crosslinking has the effect of mimicking in vivo endogenous
crosslinking found in many tissues.
[0696] Thrombin acts as a catalyst for fibrinogen to provide
fibrin, an insoluble polymer and is present in the composition in
an amount sufficient to catalyze polymerization of fibrinogen
present in the patient plasma. Thrombin also activates FXIII, a
plasma protein that catalyzes covalent crosslinks in fibrin,
rendering the resultant clot insoluble. Usually the thrombin is
present in the adhesive composition in concentration of from about
0.01 to about 1000 or greater NIH units (NIHu) of activity, usually
about i to about 500 NIHu, most usually about 200 to about 500
NIHu. The thrombin can be from a variety of host animal sources,
conveniently bovine. Thrombin is commercially available from a
variety of sources including Parke-Davis, usually lyophilized with
buffer salts and stabilizers in vials which provide thrombin
activity ranging from about 1000 NIHu to 10,000 NIHu. The thrombin
is usually prepared by reconstituting the powder by the addition of
either sterile distilled water or isotonic saline. Alternately,
thrombin analogs or reptile-sourced coagulants may be used.
[0697] The composition may additionally comprise an effective
amount of an antifibrinolytic agent to enhance the integrity of the
glue clot as the healing processes occur. A number of
antifibrinolytic agents are well known and include aprotinin,
C1-esterase inhibitor and .epsilon.-amino-n-caproic acid (EACA).
.epsilon.-amino-n-caproic acid, the only antifibrinolytic agent
approved by the FDA, is effective at a concentration of from about
5 mg/ml to about 40 mg/ml of the final adhesive composition, more
usually from about 20 to about 30 mg/ml. EACA is commercially
available as a solution having a concentration of about 250 mg/ml.
Conveniently, the commercial solution is diluted with distilled
water to provide a solution of the desired concentration. That
solution is desirably used to reconstitute lyophilized thrombin to
the desired thrombin concentration.
[0698] Other examples of in situ forming materials based on the
crosslinking of proteins are described, e.g., in U.S. Pat. Nos.
RE38158; 4,839,345; 5,514,379, 5,583,114; 6,458,147; 6,371,975;
5,290,552; 6,096,309; U.S. patent application Publication Nos.
2002/0161399; 2001/0018598 and PCT Publication Nos. WO 03/090683;
WO 01/45761; WO 99/66964 and WO 96/03159).
[0699] Self-Reactive Compounds
[0700] In one aspect, the therapeutic agent is released from a
crosslinked matrix formed, at least in part, from a self-reactive
compound. As used herein, a self-reactive compound comprises a core
substituted with a minimum of three reactive groups. The reactive
groups may be directed attached to the core of the compound, or the
reactive groups may be indirectly attached to the compound's core,
e.g., the reactive groups are joined to the core through one or
more linking groups.
[0701] Each of the three reactive groups that are necessarily
present in a self-reactive compound can undergo a bond-forming
reaction with at least one of the remaining two reactive groups.
For clarity it is mentioned that when these compounds react to form
a crosslinked matrix, it will most often happen that reactive
groups on one compound will reactive with reactive groups on
another compound. That is, the term "self-reactive" is not intended
to mean that each self-reactive compound necessarily reacts with
itself, but rather that when a plurality of identical self-reactive
compounds are in combination and undergo a crosslinking reaction,
then these compounds will react with one another to form the
matrix. The compounds are "self-reactive" in the sense that they
can react with other compounds having the identical chemical
structure as themselves.
[0702] The self-reactive compound comprises at least four
components: a core and three reactive groups. In one embodiment,
the self-reactive compound can be characterized by the formula (I),
where R is the core, the reactive groups are represented by
X.sup.1, X.sup.2 and X.sup.3, and a linker (L) is optionally
present between the core and a functional group. 115
[0703] The core R is a polyvalent moiety having attachment to at
least three groups (i.e., it is at least trivalent) and may be, or
may contain, for example, a hydrophilic polymer, a hydrophobic
polymer, an amphiphilic polymer, a C.sub.2-14 hydrocarbyl, or a
C.sub.2-14 hydrocarbyl which is heteroatom-containing. The linking
groups L.sup.1, L.sup.2, and L.sup.3 may be the same or different.
The designators p, q and r are either 0 (when no linker is present)
or 1 (when a linker is present). The reactive groups X.sup.1,
X.sup.2 and X.sup.3 may be the same or different. Each of these
reactive groups reacts with at least one other reactive group to
form a three-dimensional matrix. Therefore X.sup.1 can react with
X.sup.2 and/or X.sup.3, X.sup.2 can react with X.sup.1 and/or
X.sup.3, X.sup.3 can react with X.sup.1 and/or X.sup.2 and so
forth. A trivalent core will be directly or indirectly bonded to
three functional groups, a tetravalent core will be directly or
indirectly bonded to four functional groups, etc.
[0704] Each side chain typically has one reactive group. However,
the invention also encompasses self-reactive compounds where the
side chains contain more than one reactive group. Thus, in another
embodiment of the invention, the self-reactive compound has the
formula (II):
[X'-(L.sup.4).sub.a-Y-(L.sup.5).sub.b].sub.c-R'
[0705] where: a and b are integers from 0-1; c is an integer from
3-12; R' is selected from hydrophilic polymers, hydrophobic
polymers, amphiphilic polymers, C.sub.2-14 hydrocarbyls, and
heteroatom-containing C.sub.2-14 hydrocarbyls; X' and Y' are
reactive groups and can be the same or different; and L.sup.4 and
L.sup.5 are linking groups. Each reactive group inter-reacts with
the other reactive group to form a three-dimensional matrix. The
compound is essentially non-reactive in an initial environment but
is rendered reactive upon exposure to a modification in the initial
environment that provides a modified environment such that a
plurality of the self-reactive compounds inter-react in the
modified environment to form a three-dimensional matrix. In one
preferred embodiment, R is a hydrophilic polymer. In another
preferred embodiment, X' is a nucleophilic group and Y' is an
electrophilic group.
[0706] The following self-reactive compound is one example of a
compound of formula (II): 116
[0707] where R.sup.4 has the formula: 117
[0708] Thus, in formula (II), a and b are 1; c is 4; the core R' is
the hydrophilic polymer, tetrafunctionally activated polyethylene
glycol, (C(CH.sub.2--O--).sub.4; X' is the electrophilic reactive
group, succinimidyl; Y' is the nucleophilic reactive group
--CH--NH.sub.2; L.sup.4 is --C(O)--O--; and L.sup.5 is
--(CH.sub.2--CH.sub.2--O--CH.sub.2-
).sub.x--CH.sub.2--O--C(O)--(CH.sub.2).sub.2--.
[0709] The self-reactive compounds of the invention are readily
synthesized by techniques that are well known in the art. An
exemplary synthesis is set forth below: 118
[0710] The reactive groups are selected so that the compound is
essentially non-reactive in an initial environment. Upon exposure
to a specific modification in the initial environment, providing a
modified environment, the compound is rendered reactive and a
plurality of self-reactive compounds are then able to interreact in
the modified environment to form a three-dimensional matrix.
Examples of modification in the initial environment are detailed
below, but include the addition of an aqueous medium, a change in
pH, exposure to ultraviolet radiation, a change in temperature, or
contact with a redox initiator.
[0711] The core and reactive groups can also be selected so as to
provide a compound that has one of more of the following features:
are biocompatible, are non-immunogenic, and do not leave any toxic,
inflammatory or immunogenic reaction products at the site of
administration. Similarly, the core and reactive groups can also be
selected so as to provide a resulting matrix that has one or more
of these features.
[0712] In one embodiment of the invention, substantially
immediately or immediately upon exposure to the modified
environment, the self-reactive compounds inter-react form a
three-dimensional matrix. The term "substantially immediately" is
intended to mean within less than five minutes, preferably within
less than two minutes, and the term "immediately" is intended to
mean within less than one minute, preferably within less than 30
seconds.
[0713] In one embodiment, the self-reactive compound and resulting
matrix are not subject to enzymatic cleavage by matrix
metalloproteinases such as collagenase, and are therefore not
readily degradable in vivo. Further, the self-reactive compound may
be readily tailored, in terms of the selection and quantity of each
component, to enhance certain properties, e.g., compression
strength, swellability, tack, hydrophilicity, optical clarity, and
the like.
[0714] In one preferred embodiment, R is a hydrophilic polymer. In
another preferred embodiment, X is a nucleophilic group, Y is an
electrophilic group and Z is either an electrophilic or a
nucleophilic group. Additional embodiments are detailed below.
[0715] A higher degree of inter-reaction, e.g., crosslinking, may
be useful when a less swellable matrix is desired or increased
compressive strength is desired. In those embodiments, it may be
desirable to have n be an integer from 2-12. In addition, when a
plurality of self-reactive compounds are utilized, the compounds
may be the same or different.
[0716] E. Reactive Groups
[0717] Prior to use, the self-reactive compound is stored in an
initial environment that insures that the compound remain
essentially non-reactive until use. Upon modification of this
environment, the compound is rendered reactive and a plurality of
compounds will then inter-react to form the desired matrix. The
initial environment, as well as the modified environment, is thus
determined by the nature of the reactive groups involved.
[0718] The number of reactive groups can be the same or different.
However, in one embodiment of the invention, the number of reactive
groups is approximately equal. As used in this context, the term
"approximately" refers to a 2:1 to 1:2 ratio of moles of one
reactive group to moles of a different reactive groups. A 1:1:1
molar ratio of reactive-groups is generally preferred.
[0719] In general, the concentration of the self-reactive compounds
in the modified environment, when liquid in nature, will be in the
range of about 1 to 50 wt %, generally about 2 to 40 wt %. The
preferred concentration of the compound in the liquid will depend
on a number of factors, including the type of compound (i.e., type
of molecular core and reactive groups), its molecular weight, and
the end use of the resulting three-dimensional matrix. For example,
use of higher concentrations of the compounds, or using highly
functionalized compounds, will result in the formation of a more
tightly crosslinked network, producing a stiffer, more robust gel.
As such, compositions intended for use in tissue augmentation will
generally employ concentrations of self-reactive compounds that
fall toward the higher end of the preferred concentration range.
Compositions intended for use as bioadhesives or in adhesion
prevention do not need to be as firm and may therefore contain
lower concentrations of the self-reactive compounds.
[0720] 1) Electrophilic and Nucleophilic Reactive Groups
[0721] In one embodiment of the invention, the reactive groups are
electrophilic and nucleophilic groups, which undergo a nucleophilic
substitution reaction, a nucleophilic addition reaction, or both.
The term "electrophilic" refers to a reactive group that is
susceptible to nucleophilic attack, i.e., susceptible to reaction
with an incoming nucleophilic group. Electrophilic groups herein
are positively charged or electron-deficient, typically
electron-deficient. The term "nucleophilic" refers to a reactive
group that is electron rich, has an unshared pair of electrons
acting as a reactive site, and reacts with a positively charged or
electron-deficient site. For such reactive groups, the modification
in the initial environment comprises the addition of an aqueous
medium and/or a change in pH.
[0722] In one embodiment of the invention, X1 (also referred to
herein as X) can be a nucleophilic group and X2 (also referred to
herein as Y) can be an electrophilic group or vice versa, and X3
(also referred to herein as Z) can be either an electrophilic or a
nucleophilic group.
[0723] X may be virtually any nucleophilic group, so long as
reaction can occur with the electrophilic group Y and also with Z,
when Z is electrophilic (Z.sub.EL). Analogously, Y may be virtually
any electrophilic group, so long as reaction can take place with X
and also with Z when Z is nucleophilic (Z.sub.NU). The only
limitation is a practical one, in that reaction between X and Y,
and X and Z.sub.EL, or Y and Z.sub.NU should be fairly rapid and
take place automatically upon admixture with an aqueous medium,
without need for heat or potentially toxic or non-biodegradable
reaction catalysts or other chemical reagents. It is also preferred
although not essential that reaction occur without need for
ultraviolet or other radiation. In one embodiment, the reactions
between X and Y, and between either X and Z.sub.EL or Y and
Z.sub.NU, are complete in under 60 minutes, preferably under 30
minutes. Most preferably, the reaction occurs in about 5 to 15
minutes or less.
[0724] Examples of nucleophilic groups suitable as X or Fn.sub.NU
include, but are not limited to: --NH.sub.2, --NHR.sup.1,
--N(R.sup.1).sub.2, --SH, --OH, --COOH, --C.sub.6H.sub.4--OH, --H,
--PH.sub.2, --PHR.sup.1, --P(R.sup.1).sub.2, --NH--NH.sub.2,
--CO--NH--NH.sub.2, --C.sub.5H.sub.4N, etc. wherein R.sup.1 is a
hydrocarbyl group and each R1 may be the same or different. R.sup.1
is typically alkyl or monocyclic aryl, preferably alkyl, and most
preferably lower alkyl. Organometallic moieties are also useful
nucleophilic groups for the purposes of the invention, particularly
those that act as carbanion donors. Examples of organometallic
moieties include: Grignard functionalities --R.sup.2MgHal wherein
R.sup.2is a carbon atom (substituted or unsubstituted), and Hal is
halo, typically bromo, iodo or chloro, preferably bromo; and
lithium-containing functionalities, typically alkyllithium groups;
sodium-containing functionalities.
[0725] It will be appreciated by those of ordinary skill in the art
that certain nucleophilic groups must be activated with a base so
as to be capable of reaction with an electrophilic group. For
example, when there are nucleophilic sulfhydryl and hydroxyl groups
in the self-reactive compound, the compound must be admixed with an
aqueous base in order to remove a proton and provide an --S.sup.-
or --O.sup.- species to enable reaction with the electrophilic
group. Unless it is desirable for the base to participate in the
reaction, a non-nucleophilic base is preferred. In some
embodiments, the base may be present as a component of a buffer
solution. Suitable bases and corresponding crosslinking reactions
are described herein.
[0726] The selection of electrophilic groups provided on the
self-reactive compound, must be made so that reaction is possible
with the specific nucleophilic groups. Thus, when the X reactive
groups are amino groups, the Y and any Z.sub.EL groups are selected
so as to react with amino groups. Analogously, when the X reactive
groups are sulfhydryl moieties, the corresponding electrophilic
groups are sulfhydryl-reactive groups, and the like. In general,
examples of electrophilic groups suitable as Y or Z.sub.EL include,
but are not limited to, --CO--Cl, --(CO)--O--(CO)--R (where R is an
alkyl group), --CH.dbd.CH--CH.dbd.O and
--CH.dbd.CH--C(CH.sub.3).dbd.O, halo, --N.dbd.C.dbd.O,
--N.dbd.C.dbd.S, --SO.sub.2CH.dbd.CH.sub.2,
--O(CO)--C.dbd.CH.sub.2, --O(CO)--C(CH.sub.3).dbd.CH.sub.2,
--S--S--(C.sub.5H.sub.4N),
--O(CO)--C(CH.sub.2CH.sub.3).dbd.CH.sub.2, --CH.dbd.CH--C.dbd.NH,
--COOH, --(CO)O--N(COCH.sub.2).sub.2, --CHO,
--(CO)O--N(COCH.sub.2).sub.2--S(O).s- ub.2OH, and
--N(COCH).sub.2.
[0727] When X is amino (generally although not necessarily primary
amino), the electrophilic groups present on Y and Z.sub.EL are
amine-reactive groups. Exemplary amine-reactive groups include, by
way of example and not limitation, the following groups, or
radicals thereof: (1) carboxylic acid esters, including cyclic
esters and "activated" esters; (2) acid chloride groups (--CO--Cl);
(3) anhydrides (--(CO)--O--(CO)--R, where R is an alkyl group); (4)
ketones and aldehydes, including .alpha.,.beta.-unsaturated
aldehydes and ketones such as --CH.dbd.CH--CH.dbd.O and
--CH.dbd.CH--C(CH.sub.3).dbd.O; (5) halo groups; (6) isocyanate
group (--N.dbd.C.dbd.O); (7) thioisocyanato group
(--N.dbd.C.dbd.S); (8) epoxides; (9) activated hydroxyl groups
(e.g., activated with conventional activating agents such as
carbonyldiimidazole or sulfonyl chloride); and (10) olefins,
including conjugated olefins, such as ethenesulfonyl
(--SO.sub.2CH.dbd.CH.sub.2) and analogous functional groups,
including acrylate (--O(CO)--C.dbd.CH.sub.2), methacrylate
(--O(CO)--C(CH.sub.3).dbd.CH.sub.2), ethyl acrylate
(--O(CO)--C(CH.sub.2CH.sub.3).dbd.CH.sub.2), and ethyleneimino
(--CH.dbd.CH--C.dbd.NH).
[0728] In one embodiment the amine-reactive groups contain an
electrophilically reactive carbonyl group susceptible to
nucleophilic attack by a primary or secondary amine, for example
the carboxylic acid esters and aldehydes noted above, as well as
carboxyl groups (--COOH).
[0729] Since a carboxylic acid group per se is not susceptible to
reaction with a nucleophilic amine, components containing
carboxylic acid groups must be activated so as to be
amine-reactive. Activation may be accomplished in a variety of
ways, but often involves reaction with a suitable
hydroxyl-containing compound in the presence of a dehydrating agent
such as dicyclohexylcarbodiimide (DCC) or dicyclohexylurea (DHU).
For example, a carboxylic acid can be reacted with an
alkoxy-substituted N-hydroxy-succinimide or
N-hydroxysulfosuccinimide in the presence of DCC to form reactive
electrophilic groups, the N-hydroxysuccinimide ester and the
N-hydroxysulfosuccinimide ester, respectively. Carboxylic acids may
also be activated by reaction with an acyl halide such as an acyl
chloride (e.g., acetyl chloride), to provide a reactive anhydride
group. In a further example, a carboxylic acid may be converted to
an acid chloride group using, e.g., thionyl chloride or an acyl
chloride capable of an exchange reaction. Specific reagents and
procedures used to carry out such activation reactions will be
known to those of ordinary skill in the art and are described in
the pertinent texts and literature.
[0730] Accordingly, in one embodiment, the amine-reactive groups
are selected from succinimidyl ester
(--O(CO)--N(COCH.sub.2).sub.2), sulfosuccinimidyl ester
(--O(CO)--N(COCH.sub.2).sub.2--S(O).sub.2OH), maleimido
(--N(COCH).sub.2), epoxy, isocyanato, thioisocyanato, and
ethenesulfonyl.
[0731] Analogously, when X is sulfhydryl, the electrophilic groups
present on Y and Z.sub.EL are groups that react with a sulfhydryl
moiety. Such reactive groups include those that form thioester
linkages upon reaction with a sulfhydryl group, such as those
described in WO 00/62827 to Wallace et al. As explained in detail
therein, sulfhydryl reactive groups include, but are not limited
to: mixed anhydrides; ester derivatives of phosphorus; ester
derivatives of p-nitrophenol, p-nitrothiophenol and
pentafluorophenol; esters of substituted hydroxylamines, including
N-hydroxyphthalimide esters, N-hydroxysuccinimide esters,
N-hydroxysulfosuccinimide esters, and N-hydroxyglutarimide esters;
esters of 1-hydroxybenzotriazole;
3-hydroxy-3,4-dihydro-benzotriazin-4-one;
3-hydroxy-3,4-dihydro-quinazoline-4-one; carbonylimidazole
derivatives; acid chlorides; ketenes; and isocyanates. With these
sulfhydryl reactive groups, auxiliary reagents can also be used to
facilitate bond formation, e.g.,
1-ethyl-3-[3-dimethylaminopropyl]carbodiimide can be used to
facilitate coupling of sulfhydryl groups to carboxyl-containing
groups.
[0732] In addition to the sulfhydryl reactive groups that form
thioester linkages, various other sulfhydryl reactive
functionalities can be utilized that form other types of linkages.
For example, compounds that contain methyl imidate derivatives form
imido-thioester linkages with sulfhydryl groups. Alternatively,
sulfhydryl reactive groups can be employed that form disulfide
bonds with sulfhydryl groups; such groups generally have the
structure --S--S--Ar where Ar is a substituted or unsubstituted
nitrogen-containing heteroaromatic moiety or a non-heterocyclic
aromatic group substituted with an electron-withdrawing moiety,
such that Ar may be, for example, 4-pyridinyl, o-nitrophenyl,
m-nitrophenyl, p-nitrophenyl, 2,4-dinitrophenyl, 2-nitro-4-benzoic
acid, 2-nitro-4-pyridinyl, etc. In such instances, auxiliary
reagents, i.e., mild oxidizing agents such as hydrogen peroxide,
can be used to facilitate disulfide bond formation.
[0733] Yet another class of sulfhydryl reactive groups forms
thioether bonds with sulfhydryl groups. Such groups include, inter
alia, maleimido, substituted maleimido, haloalkyl, epoxy, imino,
and aziridino, as well as olefins (including conjugated olefins)
such as ethenesulfonyl, etheneimino, acrylate, methacrylate, and
.alpha.,.beta.-unsaturated aldehydes and ketones.
[0734] When X is --OH, the electrophilic functional groups on the
remaining component(s) must react with hydroxyl groups. The
hydroxyl group may be activated as described above with respect to
carboxylic acid groups, or it may react directly in the presence of
base with a sufficiently reactive electrophilic group such as an
epoxide group, an aziridine group, an acyl halide, an anhydride,
and so forth.
[0735] When X is an organometallic nucleophilic group such as a
Grignard functionality or an alkyllithium group, suitable
electrophilic functional groups for reaction therewith are those
containing carbonyl groups, including, by way of example, ketones
and aldehydes.
[0736] It will also be appreciated that certain functional groups
can react as nucleophilic or as electrophilic groups, depending on
the selected reaction partner and/or the reaction conditions. For
example, a carboxylic acid group can act as a nucleophilic group in
the presence of a fairly strong base, but generally acts as an
electrophilic group allowing nucleophilic attack at the carbonyl
carbon and concomitant replacement of the hydroxyl group with the
incoming nucleophilic group.
[0737] These, as well as other embodiments are illustrated below,
where the covalent linkages in the matrix that result upon covalent
binding of specific nucleophilic reactive groups to specific
electrophilic reactive groups on the self-reactive compound
include, solely by way of example, the following Table:
33TABLE Representative Nucleophilic Representative Electrophilic
Group (X, Z.sub.NU) Group (Y, Z.sub.EL) Resulting Linkage
--NH.sub.2 --O--(CO)--O--N(COCH.sub.2).sub.2 --NH--(CO)--O--
succinimidyl carbonate terminus --SH
--O--(CO)--O--N(COCH.sub.2).sub.2 --S--(CO)--O-- --OH
--O--(CO)--O--N(COCH.sub.2).sub.2 --O--(CO)-- --NH.sub.2
--O(CO)--CH.dbd.CH.sub.2 --NH--CH.sub.2CH.sub.2--(CO)--- O--
acrylate terminus --SH --O--(CO)--CH.dbd.CH.sub.2
--S--CH.sub.2CH.sub.2--(CO)--O-- --OH --O--(CO)--CH.dbd.CH.sub.2
--O--CH.sub.2CH.sub.2--(CO)--O-- --NH.sub.2
--O(CO)--(CH.sub.2).sub.3--CO.sub.2--N(COCH.sub.2).sub.2
--NH--(CO)--(CH.sub.2).sub.3--(CO)--O-- succinimidyl glutarate
terminus --SH --O(CO)--(CH.sub.2).sub.3--CO.sub.2--N(COCH.sub.2).s-
ub.2 --S--(CO)--(CH.sub.2).sub.3--(CO)--O-- --OH
--O(CO)--(CH.sub.2).sub.3--CO.sub.2--N(COCH.sub.2).sub.2
--O--(CO)--(CH.sub.2).sub.3--(CO)--O-- --NH.sub.2
--O--CH.sub.2--CO.sub.2--N(COCH.sub.2).sub.2
--NH--(CO)--CH.sub.2--O-- succinimidyl acetate terminus --SH
--O--CH.sub.2--CO.sub.2--N- (COCH.sub.2).sub.2
--S--(CO)--CH.sub.2--O-- --OH
--O--CH.sub.2--CO.sub.2--N(COCH.sub.2).sub.2
--O--(CO)--CH.sub.2--O-- --NH.sub.2
--O--NH(CO)--(CH.sub.2).sub.2--CO.sub.2--
--NH--(CO)--(CH.sub.2).sub.2--(CO)-- N(COCH.sub.2).sub.2 NH--O--
succinimidyl succinamide terminus --SH
--O--NH(CO)--(CH.sub.2).sub.2--CO.sub.2--
--S--(CO)--(CH.sub.2).sub.2--(C- O)-- N(COCH.sub.2).sub.2 NH--O--
--OH --O--NH(CO)--(CH.sub.2).sub.2--CO.sub.2--
--O--(CO)--(CH.sub.2).sub.2--(C- O)-- N(COCH.sub.2).sub.2 NH--O--
--NH.sub.2 --O--(CH.sub.2).sub.2--CHO
--NH--(CO)--(CH.sub.2).sub.2--O-- propionaldehyde terminus
--NH.sub.2 119 --NH--CH.sub.2--CH(OH)--CH.sub.2--O-- and
--N[CH.sub.2--CH(OH)--CH.sub.2-- -O--].sub.2 --NH.sub.2
--O--(CH.sub.2).sub.2--N.dbd.C.dbd.- O
--NH--(CO)--NH--CH.sub.2--O-- (isocyanate terminus) --NH.sub.2
--SO.sub.2--CH.dbd.CH.sub.2 --NH--CH.sub.2CH.sub.2--SO.sub.2--
vinyl sulfone terminus --SH --SO.sub.2--CH.dbd.CH.sub.2
--S--CH.sub.2CH.sub.2--SO.sub.2--
[0738] For self-reactive compounds containing electrophilic and
nucleophilic reactive groups, the initial environment typically can
be dry and sterile. Since electrophilic groups react with water,
storage in sterile, dry form will prevent hydrolysis. The dry
synthetic polymer may be compression molded into a thin sheet or
membrane, which can then be sterilized using gamma or e-beam
irradiation. The resulting dry membrane or sheet can be cut to the
desired size or chopped into smaller size particulates. The
modification of a dry initial environment will typically comprise
the addition of an aqueous medium.
[0739] In one embodiment, the initial environment can be an aqueous
medium such as in a low pH buffer, i.e., having a pH less than
about 6.0, in which both electrophilic and nucleophilic groups are
non-reactive. Suitable liquid media for storage of such compounds
include aqueous buffer solutions such as monobasic sodium
phosphate/dibasic sodium phosphate, sodium carbonate/sodium
bicarbonate, glutamate or acetate, at a concentration of 0.5 to 300
mM. Modification of an initial low pH aqueous environment will
typically comprise increasing the pH to at least pH 7.0, more
preferably increasing the pH to at least pH 9.5.
[0740] In another embodiment the modification of a dry initial
environment comprises dissolving the self-reactive compound in a
first buffer solution having a pH within the range of about 1.0 to
5.5 to form a homogeneous solution, and (ii) adding a second buffer
solution having a pH within the range of about 6.0 to 11.0 to the
homogeneous solution. The buffer solutions are aqueous and can be
any pharmaceutically acceptable basic or acid composition. The term
"buffer" is used in a general sense to refer to an acidic or basic
aqueous solution, where the solution may or may not be functioning
to provide a buffering effect (i.e., resistance to change in pH
upon addition of acid or base) in the compositions of the present
invention. For example, the self-reactive compound can be in the
form of a homogeneous dry powder. This powder is then combined with
a buffer solution having a pH within the range of about 1.0 to 5.5
to form a homogeneous acidic aqueous solution, and this solution is
then combined with a buffer solution having a pH within the range
of about 6.0 to 11.0 to form a reactive solution. For example,
0.375 grams of the dry powder can be combined with 0.75 grams of
the acid buffer to provide, after mixing, a homogeneous solution,
where this solution is combined with 1.1 grams of the basic buffer
to provide a reactive mixture that substantially immediately forms
a three-dimensional matrix.
[0741] Acidic buffer solutions having a pH within the range of
about 1.0 to 5.5, include by way of illustration and not
limitation, solutions of: citric acid, hydrochloric acid,
phosphoric acid, sulfuric acid, AMPSO
(3-[(1,1-dimethyl-2-hydroxyethyl)amino]2-hydroxy-propane-sulfonic
acid), acetic acid, lactic acid, and combinations thereof. In a
preferred embodiment, the acidic buffer solution is a solution of
citric acid, hydrochloric acid, phosphoric acid, sulfuric acid, and
combinations thereof. Regardless of the precise acidifying agent,
the acidic buffer preferably has a pH such that it retards the
reactivity of the nucleophilic groups on the core. For example, a
pH of 2.1 is generally sufficient to retard the nucleophilicity of
thiol groups. A lower pH is typically preferred when the core
contains amine groups as the nucleophilic groups. In general, the
acidic buffer is an acidic solution that, when contacted with
nucleophilic groups, renders those nucleophilic groups relatively
non-nucleophilic.
[0742] An exemplary acidic buffer is a solution of hydrochloric
acid, having a concentration of about 6.3 mM and a pH in the range
of 2.1 to 2.3. This buffer may be prepared by combining
concentrated hydrochloric acid with water, i.e., by diluting
concentrated hydrochloric acid with water. Similarly, this buffer A
may also be conveniently prepared by diluting 1.23 grams of
concentrated hydrochloric acid to a volume of 2 liters, or diluting
1.84 grams of concentrated hydrochloric acid to a volume to 3
liters, or diluting 2.45 grams of concentrated hydrochloric acid to
a volume of 4 liters, or diluting 3.07 grams concentrated
hydrochloric acid to a volume of 5 liters, or diluting 3.68 grams
of concentrated hydrochloric acid to a volume to 6 liters. For
safety reasons, the concentrated acid is preferably added to
water.
[0743] Basic buffer solutions having a pH within the range of about
6.0 to 11.0, include by way of illustration and not limitation,
solutions of: glutamate, acetate, carbonate and carbonate salts
(e.g., sodium carbonate, sodium carbonate monohydrate and sodium
bicarbonate), borate, phosphate and phosphate salts (e.g.,
monobasic sodium phosphate monohydrate and dibasic sodium
phosphate), and combinations thereof. In a preferred embodiment,
the basic buffer solution is a solution of carbonate salts,
phosphate salts, and combinations thereof.
[0744] In general, the basic buffer is an aqueous solution that
neutralizes the effect of the acidic buffer, when it is added to
the homogeneous solution of the compound and first buffer, so that
the nucleophilic groups on the core regain their nucleophilic
character (that has been masked by the action of the acidic
buffer), thus allowing the nucleophilic groups to inter-react with
the electrophilic groups on the core.
[0745] An exemplary basic buffer is an aqueous solution of
carbonate and phosphate salts. This buffer may be prepared by
combining a base solution with a salt solution. The salt solution
may be prepared by combining 34.7 g of monobasic sodium phosphate
monohydrate, 49.3 g of sodium carbonate monohydrate, and sufficient
water to provide a solution volume of 2 liter. Similarly, a 6 liter
solution may be prepared by combining 104.0 g of monobasic sodium
phosphate monohydrate, 147.94 g of sodium carbonate monohydrate,
and sufficient water to provide 6 liter of the salt solution. The
basic buffer may be prepared by combining 7.2 g of sodium hydroxide
with 180.0 g of water. The basic buffer is typically prepared by
adding the base solution as needed to the salt solution, ultimately
to provide a mixture having the desired pH, e.g., a pH of 9.65 to
9.75.
[0746] In general, the basic species present in the basic buffer
should be sufficiently basic to neutralize the acidity provided by
the acidic buffer, but should not be so nucleophilic itself that it
will react substantially with the electrophilic groups on the core.
For this reason, relatively "soft" bases such as carbonate and
phosphate are preferred in this embodiment of the invention.
[0747] To illustrate the preparation of a three-dimensional matrix
of the present invention, one may combine an admixture of the
self-reactive compound with a first, acidic, buffer (e.g., an acid
solution, e.g., a dilute hydrochloric acid solution) to form a
homogeneous solution. This homogeneous solution is mixed with a
second, basic, buffer (e.g., a basic solution, e.g., an aqueous
solution containing phosphate and carbonate salts) whereupon the
reactive groups on the core of the self-reactive compound
substantially immediately inter-react with one another to form a
three-dimensional matrix.
[0748] 2) Redox Reactive Groups
[0749] In one embodiment of the invention, the reactive groups are
vinyl groups such as styrene derivatives, which undergo a radical
polymerization upon initiation with a redox initiator. The term
"redox" refers to a reactive group that is susceptible to
oxidation-reduction activation. The term "vinyl" refers to a
reactive group that is activated by a redox initiator, and forms a
radical upon reaction. X, Y and Z can be the same or different
vinyl groups, for example, methacrylic groups.
[0750] For self-reactive compounds containing vinyl reactive
groups, the initial environment typically will be an aqueous
environment. The modification of the initial environment involves
the addition of a redox initiator.
[0751] 3) Oxidative Coupling Reactive Groups
[0752] In one embodiment of the invention, the reactive groups
undergo an oxidative coupling reaction. For example, X, Y and Z can
be a halo group such as chloro, with an adjacent
electron-withdrawing group on the halogen-bearing carbon (e.g., on
the "L" linking group). Exemplary electron-withdrawing groups
include nitro, aryl, and so forth.
[0753] For such reactive groups, the modification in the initial
environment comprises a change in pH. For example, in the presence
of a base such as KOH, the self-reactive compounds then undergo a
de-hydro, chloro coupling reaction, forming a double bond between
the carbon atoms, as illustrated below: 120
[0754] For self-reactive compounds containing oxidative coupling
reactive groups, the initial environment typically can be can be
dry and sterile, or a non-basic medium. The modification of the
initial environment will typically comprise the addition of a
base.
[0755] 4) Photoinitiated Reactive Groups
[0756] In one embodiment of the invention, the reactive groups are
photoinitiated groups. For such reactive groups, the modification
in the initial environment comprises exposure to ultraviolet
radiation.
[0757] In one embodiment of the invention, X can be an azide
(--N.sub.3) group and Y can be an alkyl group such as
--CH(CH.sub.3).sub.2 or vice versa. Exposure to ultraviolet
radiation will then form a bond between the groups to provide for
the following linkage: --NH--C(CH.sub.3).sub.2-- -CH.sub.2--. In
another embodiment of the invention, X can be a benzophenone
(--(C.sub.6H.sub.4)--C(O)--(C.sub.6H.sub.5)) group and Y can be an
alkyl group such as --CH(CH.sub.3).sub.2 or vice versa. Exposure to
ultraviolet radiation will then form a bond between the groups to
provide for the following linkage: 121
[0758] For self-reactive compounds containing photoinitiated
reactive groups, the initial environment typically will be in an
ultraviolet radiation-shielded environment. This can be for
example, storage within a container that is impermeable to
ultraviolet radiation.
[0759] The modification of the initial environment will typically
comprise exposure to ultraviolet radiation.
[0760] 5) Temperature-Sensitive Reactive Groups
[0761] In one embodiment of the invention, the reactive groups are
temperature-sensitive groups, which undergo a thermochemical
reaction. For such reactive groups, the modification in the initial
environment thus comprises a change in temperature. The term
"temperature-sensitive" refers to a reactive group that is
chemically inert at one temperature or temperature range and
reactive at a different temperature or temperature range.
[0762] In one embodiment of the invention, X, Y, and Z are the same
or different vinyl groups.
[0763] For self-reactive compounds containing reactive groups that
are temperature-sensitive, the initial environment typically will
be within the range of about 10 to 30.degree. C.
[0764] The modification of the initial environment will typically
comprise changing the temperature to within the range of about 20
to 40.degree. C.
[0765] F. Linking Groups
[0766] The reactive groups may be directly attached to the core, or
they may be indirectly attached through a linking group, with
longer linking groups also termed "chain extenders." In the formula
(I) shown above, the optional linker groups are represented by
L.sup.1, L.sup.2, and L.sup.3, wherein the linking groups are
present when p, q and r are equal to 1.
[0767] Suitable linking groups are well known in the art. See, for
example, WO 97/22371 to Rhee et al. Linking groups are useful to
avoid steric hindrance problems that can sometimes associated with
the formation of direct linkages between molecules. Linking groups
may additionally be used to link several self-reactive compounds
together to make larger molecules. In one embodiment, a linking
group can be used to alter the degradative properties of the
compositions after administration and resultant gel formation. For
example, linking groups can be used to promote hydrolysis, to
discourage hydrolysis, or to provide a site for enzymatic
degradation.
[0768] Examples of linking groups that provide hydrolyzable sites,
include, inter alia: ester linkages; anhydride linkages, such as
those obtained by incorporation of glutarate and succinate; ortho
ester linkages; ortho carbonate linkages such as trimethylene
carbonate; amide linkages; phosphoester linkages; .alpha.-hydroxy
acid linkages, such as those obtained by incorporation of lactic
acid and glycolic acid; lactone-based linkages, such as those
obtained by incorporation of caprolactone, valerolactone,
.gamma.-butyrolactone and p-dioxanone; and amide linkages such as
in a dimeric, oligomeric, or poly(amino acid) segment. Examples of
non-degradable linking groups include succinimide, propionic acid
and carboxymethylate linkages. See, for example, WO 99/07417 to
Coury et al. Examples of enzymatically degradable linkages include
Leu-Gly-Pro-Ala, which is degraded by collagenase; and Gly-Pro-Lys,
which is degraded by plasmin.
[0769] Linking groups can also be included to enhance or suppress
the reactivity of the various reactive groups. For example,
electron-withdrawing groups within one or two carbons of a
sulfhydryl group would be expected to diminish its effectiveness in
coupling, due to a lowering of nucleophilicity. Carbon-carbon
double bonds and carbonyl groups will also have such an effect.
Conversely, electron-withdrawing groups adjacent to a carbonyl
group (e.g., the reactive carbonyl of
glutaryl-N-hydroxysuccinimidyl) would increase the reactivity of
the carbonyl carbon with respect to an incoming nucleophilic group.
By contrast, sterically bulky groups in the vicinity of a reactive
group can be used to diminish reactivity and thus reduce the
coupling rate as a result of steric hindrance.
[0770] By way of example, particular linking groups and
corresponding formulas are indicated in the following Table:
34 TABLE Linking group Component structure --O--(CH.sub.2).sub.x--
--O--(CH.sub.2).sub.x--X --O--(CH.sub.2).sub.x--Y
--O--(CH.sub.2).sub.x--Z --S--(CH.sub.2).sub.x--
--S--(CH.sub.2).sub.x--X --S--(CH.sub.2).sub.x--Y
--S--(CH.sub.2).sub.x--Z --NH--(CH.sub.2).sub.x--
--NH--(CH.sub.2).sub.x--X --NH--(CH.sub.2).sub.x--Y
--NH--(CH.sub.2).sub.x--Z --O--(CO)--NH--(CH.sub.2).sub.x--
--O--(CO)--NH--(CH.sub.2).sub.x--X
--O--(CO)--NH--(CH.sub.2).sub.x--Y --O--(CO)--NH--(CH.sub.2)-
.sub.x--Z --NH--(CO)--O--(CH.sub.2).sub.x--
--NH--(CO)--O--(CH.sub.2).sub.x--X --NH--(CO)--O--(CH.sub.2).sub-
.x--Y --NH--(CO)--O--(CH.sub.2).sub.x--Z
--O--(CO)--(CH.sub.2).sub.x-- --O--(CO)--(CH.sub.2).sub.x--X
--O--(CO)--(CH.sub.2).sub.x--Y --O--(CO)--(CH.sub.2).sub.x--Z
--(CO)--O--(CH.sub.2).sub.x-- --(CO)--O--(CH.sub.2).sub.n--X
--(CO)--O--(CH.sub.2).sub.n--Y --(CO)--O--(CH.sub.2).sub.n--Z
--O--(CO)--O--(CH.sub.2).sub.x-- --O--(CO)--O--(CH.sub.2).sub.x--X
--O--(CO)--O--(CH.sub.2).sub.x--Y --O--(CO)--O--(CH.sub.2).sub.x--Z
--O--(CO)--CHR.sup.2-- --O--(CO)--CHR.sup.2--X
--O--(CO)--CHR.sup.2--Y --O--(CO)--CHR.sup.2--Z
--O--R.sup.3--(CO)--NH-- --O--R.sup.3--(CO)--NH--X
--O--R.sup.3--(CO)--NH--Y --O--R.sup.3--(CO)--NH--Z
[0771] In the above Table, x is generally in the range of 1 to
about 10; R.sup.2 is generally hydrocarbyl, typically alkyl or
aryl, preferably alkyl, and most preferably lower alkyl; and
R.sup.3 is hydrocarbylene, heteroatom-containing hydrocarbylene,
substituted hydrocarbylene, or substituted heteroatom-containing
hydrocarbylene) typically alkylene or arylene (again, optionally
substituted and/or containing a heteroatom), preferably lower
alkylene (e.g., methylene, ethylene, n-propylene, n-butylene,
etc.), phenylene, or amidoalkylene (e.g.,
--(CO)--NH--CH.sub.2).
[0772] Other general principles that should be considered with
respect to linking groups are as follows. If a higher molecular
weight self-reactive compound is to be used, it will preferably
have biodegradable linkages as described above, so that fragments
larger than 20,000 mol. wt. are not generated during resorption in
the body. In addition, to promote water miscibility and/or
solubility, it may be desired to add sufficient electric charge or
hydrophilicity. Hydrophilic groups can be easily introduced using
known chemical synthesis, so long as they do not give rise to
unwanted swelling or an undesirable decrease in compressive
strength. In particular, polyalkoxy segments may weaken gel
strength.
[0773] G. The Core
[0774] The "core" of each self-reactive compound is comprised of
the molecular structure to which the reactive groups are bound. The
molecular core can a polymer, which includes synthetic polymers and
naturally occurring polymers. In one embodiment, the core is a
polymer containing repeating monomer units. The polymers can be
hydrophilic, hydrophobic, or amphiphilic. The molecular core can
also be a low molecular weight components such as a C.sub.2-14
hydrocarbyl or a heteroatom-containing C.sub.2-14 hydrocarbyl. The
heteroatom-containing C.sub.2-14 hydrocarbyl can have 1 or 2
heteroatoms selected from N, O and S. In a preferred embodiment,
the self-reactive compound comprises a molecular core of a
synthetic hydrophilic polymer.
[0775] 1) Hydrophilic Polymers
[0776] As mentioned above, the term "hydrophilic polymer" as used
herein refers to a polymer having an average molecular weight and
composition that naturally renders, or is selected to render the
polymer as a whole "hydrophilic." Preferred polymers are highly
pure or are purified to a highly pure state such that the polymer
is or is treated to become pharmaceutically pure. Most hydrophilic
polymers can be rendered water soluble by incorporating a
sufficient number of oxygen (or less frequently nitrogen) atoms
available for forming hydrogen bonds in aqueous solutions.
[0777] Synthetic hydrophilic polymers may be homopolymers, block
copolymers including di-block and tri-block copolymers, random
copolymers, or graft copolymers. In addition, the polymer may be
linear or branched, and if branched, may be minimally to highly
branched, dendrimeric, hyperbranched, or a star polymer. The
polymer may include biodegradable segments and blocks, either
distributed throughout the polymer's molecular structure or present
as a single block, as in a block copolymer. Biodegradable segments
preferably degrade so as to break covalent bonds. Typically,
biodegradable segments are segments that are hydrolyzed in the
presence of water and/or enzymatically cleaved in situ.
Biodegradable segments may be composed of small molecular segments
such as ester linkages, anhydride linkages, ortho ester linkages,
ortho carbonate linkages, amide linkages, phosphonate linkages,
etc. Larger biodegradable "blocks" will generally be composed of
oligomeric or polymeric segments incorporated within the
hydrophilic polymer. Illustrative oligomeric and polymeric segments
that are biodegradable include, by way of example, poly(amino acid)
segments, poly(orthoester) segments, poly(orthocarbonate) segments,
and the like. Other biodegradable segments that may form part of
the hydrophilic polymer core include polyesters such as
polylactide, polyethers such as polyalkylene oxide, polyamides such
as a protein, and polyurethanes. For example, the core of the
self-reactive compound can be a diblock copolymer of
tetrafunctionally activated polyethylene glycol and
polylactide.
[0778] Synthetic hydrophilic polymers that are useful herein
include, but are not limited to: polyalkylene oxides, particularly
polyethylene glycol (PEG) and poly(ethylene oxide)-poly(propylene
oxide) copolymers, including block and random copolymers; polyols
such as glycerol, polyglycerol (PG) and particularly highly
branched polyglycerol, propylene glycol;
poly(oxyalkylene)-substituted diols, and
poly(oxyalkylene)-substituted polyols such as mono-, di- and
tri-polyoxyethylated glycerol, mono- and di-polyoxyethylated
propylene glycol, and mono- and di-polyoxyethylated trimethylene
glycol; polyoxyethylated sorbitol, polyoxyethylated glucose;
poly(acrylic acids) and analogs and copolymers thereof, such as
polyacrylic acid per se, polymethacrylic acid,
poly(hydroxyethylmethacrylate), poly(hydroxyethylacrylate),
poly(methylalkylsulfoxide methacrylates), poly(methylalkylsulfoxide
acrylates) and copolymers of any of the foregoing, and/or with
additional acrylate species such as aminoethyl acrylate and
mono-2-(acryloxy)-ethyl succinate; polymaleic acid;
poly(acrylamides) such as polyacrylamide per se,
poly(methacrylamide), poly(dimethylacrylamide),
poly(N-isopropyl-acrylamide), and copolymers thereof; poly(olefinic
alcohols) such as poly(vinyl alcohols) and copolymers thereof;
poly(N-vinyl lactams) such as poly(vinyl pyrrolidones),
poly(N-vinyl caprolactams), and copolymers thereof; polyoxazolines,
including poly(methyloxazoline) and poly(ethyloxazoline); and
polyvinylamines; as well as copolymers of any of the foregoing. It
must be emphasized that the aforementioned list of polymers is not
exhaustive, and a variety of other synthetic hydrophilic polymers
may be used, as will be appreciated by those skilled in the
art.
[0779] Those of ordinary skill in the art will appreciate that
synthetic polymers such as polyethylene glycol cannot be prepared
practically to have exact molecular weights, and that the term
"molecular weight" as used herein refers to the weight average
molecular weight of a number of molecules in any given sample, as
commonly used in the art. Thus, a sample of PEG 2,000 might contain
a statistical mixture of polymer molecules ranging in weight from,
for example, 1,500 to 2,500 daltons with one molecule differing
slightly from the next over a range. Specification of a range of
molecular weights indicates that the average molecular weight may
be any value between the limits specified, and may include
molecules outside those limits. Thus, a molecular weight range of
about 800 to about 20,000 indicates an average molecular weight of
at least about 800, ranging up to about 20 kDa.
[0780] Other suitable synthetic hydrophilic polymers include
chemically synthesized polypeptides, particularly polynucleophilic
polypeptides that have been synthesized to incorporate amino acids
containing primary amino groups (such as lysine) and/or amino acids
containing thiol groups (such as cysteine). Poly(lysine), a
synthetically produced polymer of the amino acid lysine (145 MW),
is particularly preferred. Poly(lysine)s have been prepared having
anywhere from 6 to about 4,000 primary amino groups, corresponding
to molecular weights of about 870 to about 580,000. Poly(lysine)s
for use in the present invention preferably have a molecular weight
within the range of about 1,000 to about 300,000, more preferably
within the range of about 5,000 to about 100,000, and most
preferably, within the range of about 8,000 to about 15,000.
Poly(lysine)s of varying molecular weights are commercially
available from Peninsula Laboratories, Inc. (Belmont, Calif.).
[0781] Although a variety of different synthetic hydrophilic
polymers can be used in the present compounds, preferred synthetic
hydrophilic polymers are PEG and PG, particularly highly branched
PG. Various forms of PEG are extensively used in the modification
of biologically active molecules because PEG lacks toxicity,
antigenicity, and immunogenicity (i.e., is biocompatible), can be
formulated so as to have a wide range of solubilities, and does not
typically interfere with the enzymatic activities and/or
conformations of peptides. A particularly preferred synthetic
hydrophilic polymer for certain applications is a PEG having a
molecular weight within the range of about 100 to about 100,000,
although for highly branched PEG, far higher molecular weight
polymers can be employed, up to 1,000,000 or more, providing that
biodegradable sites are incorporated ensuring that all degradation
products will have a molecular weight of less than about 30,000.
For most PEGs, however, the preferred molecular weight is about
1,000 to about 20,000, more preferably within the range of about
7,500 to about 20,000. Most preferably, the polyethylene glycol has
a molecular weight of approximately 10,000.
[0782] Naturally occurring hydrophilic polymers include, but are
not limited to: proteins such as collagen, fibronectin, albumins,
globulins, fibrinogen, fibrin and thrombin, with collagen
particularly preferred; carboxylated polysaccharides such as
polymannuronic acid and polygalacturonic acid; aminated
polysaccharides, particularly the glycosaminoglycans, e.g.,
hyaluronic acid, chitin, chondroitin sulfate A, B, or C, keratin
sulfate, keratosulfate and heparin; and activated polysaccharides
such as dextran and starch derivatives. Collagen and
glycosaminoglycans are preferred naturally occurring hydrophilic
polymers for use herein.
[0783] Unless otherwise specified, the term "collagen" as used
herein refers to all forms of collagen, including those, which have
been processed or otherwise modified. Thus, collagen from any
source may be used in the compounds of the invention; for example,
collagen may be extracted and purified from human or other
mammalian source, such as bovine or porcine corium and human
placenta, or may be recombinantly or otherwise produced. The
preparation of purified, substantially non-antigenic collagen in
solution from bovine skin is well known in the art. For example,
U.S. Pat. No. 5,428,022 to Palefsky et al. discloses methods of
extracting and purifying collagen from the human placenta, and U.S.
Pat. No. 5,667,839 to Berg discloses methods of producing
recombinant human collagen in the milk of transgenic animals,
including transgenic cows. Non-transgenic, recombinant collagen
expression in yeast and other cell lines) is described in U.S. Pat.
No. 6,413,742 to Olsen et al., U.S. Pat. No. 6,428,978 to Olsen et
al., and U.S. Pat. No. 6,653,450 to Berg et al.
[0784] Collagen of any type, including, but not limited to, types
I, II, III, IV, or any combination thereof, may be used in the
compounds of the invention, although type I is generally preferred.
Either atelopeptide or telopeptide-containing collagen may be used;
however, when collagen from a natural source, such as bovine
collagen, is used, atelopeptide collagen is generally preferred,
because of its reduced immunogenicity compared to
telopeptide-containing collagen.
[0785] Collagen that has not been previously crosslinked by methods
such as heat, irradiation, or chemical crosslinking agents is
preferred for use in the invention, although previously crosslinked
collagen may be used.
[0786] Collagens for use in the present invention are generally,
although not necessarily, in aqueous suspension at a concentration
between about 20 mg/ml to about 120 mg/ml, preferably between about
30 mg/ml to about 90 mg/ml. Although intact collagen is preferred,
denatured collagen, commonly known as gelatin, can also be used.
Gelatin may have the added benefit of being degradable faster than
collagen.
[0787] Nonfibrillar collagen is generally preferred for use in
compounds of the invention, although fibrillar collagens may also
be used. The term "nonfibrillar collagen" refers to any modified or
unmodified collagen material that is in substantially nonfibrillar
form, i.e., molecular collagen that is not tightly associated with
other collagen molecules so as to form fibers. Typically, a
solution of nonfibrillar collagen is more transparent than is a
solution of fibrillar collagen. Collagen types that are
nonfibrillar (or microfibrillar) in native form include types IV,
VI, and VII.
[0788] Chemically modified collagens that are in nonfibrillar form
at neutral pH include succinylated collagen and methylated
collagen, both of which can be prepared according to the methods
described in U.S. Pat. No. 4,164,559 to Miyata et al. Methylated
collagen, which contains reactive amine groups, is a preferred
nucleophile-containing component in the compositions of the present
invention. In another aspect, methylated collagen is a component
that is present in addition to first and second components in the
matrix-forming reaction of the present invention. Methylated
collagen is described in, for example, in U.S. Pat. No. 5,614,587
to Rhee et al.
[0789] Collagens for use in the compositions of the present
invention may start out in fibrillar form, then can be rendered
nonfibrillar by the addition of one or more fiber disassembly
agent. The fiber disassembly agent must be present in an amount
sufficient to render the collagen substantially nonfibrillar at pH
7, as described above. Fiber disassembly agents for use in the
present invention include, without limitation, various
biocompatible alcohols, amino acids, inorganic salts, and
carbohydrates, with biocompatible alcohols being particularly
preferred. Preferred biocompatible alcohols include glycerol and
propylene glycol. Non-biocompatible alcohols, such as ethanol,
methanol, and isopropanol, are not preferred for use in the present
invention, due to their potentially deleterious effects on the body
of the patient receiving them. Preferred amino acids include
arginine. Preferred inorganic salts include sodium chloride and
potassium chloride. Although carbohydrates, such as various sugars
including sucrose, may be used in the practice of the present
invention, they are not as preferred as other types of fiber
disassembly agents because they can have cytotoxic effects in
vivo.
[0790] Fibrillar collagen is less preferred for use in the
compounds of the invention. However, as disclosed in U.S. Pat. No.
5,614,587 to Rhee et al., fibrillar collagen, or mixtures of
nonfibrillar and fibrillar collagen, may be preferred for use in
compounds intended for long-term persistence in vivo.
[0791] 2) Hydrophobic Polymers
[0792] The core of the self-reactive compound may also comprise a
hydrophobic polymer, including low molecular weight polyfunctional
species, although for most uses hydrophilic polymers are preferred.
Generally, "hydrophobic polymers" herein contain a relatively small
proportion of oxygen and/or nitrogen atoms. Preferred hydrophobic
polymers for use in the invention generally have a carbon chain
that is no longer than about 14 carbons. Polymers having carbon
chains substantially longer than 14 carbons generally have very
poor solubility in aqueous solutions and, as such, have very long
reaction times when mixed with aqueous solutions of synthetic
polymers containing, for example, multiple nucleophilic groups.
Thus, use of short-chain oligomers can avoid solubility-related
problems during reaction. Polylactic acid and polyglycolic acid are
examples of two particularly suitable hydrophobic polymers.
[0793] 3) Amphiphilic Polymers
[0794] Generally, amphiphilic polymers have a hydrophilic portion
and a hydrophobic (or lipophilic) portion. The hydrophilic portion
can be at one end of the core and the hydrophobic portion at the
opposite end, or the hydrophilic and hydrophobic portions may be
distributed randomly (random copolymer) or in the form of sequences
or grafts (block copolymer) to form the amphiphilic polymer core of
the self-reactive compound. The hydrophilic and hydrophobic
portions may include any of the aforementioned hydrophilic and
hydrophobic polymers.
[0795] Alternately, the amphiphilic polymer core can be a
hydrophilic polymer that has been modified with hydrophobic
moieties (e.g., alkylated PEG or a hydrophilic polymer modified
with one or more fatty chains ), or a hydrophobic polymer that has
been modified with hydrophilic moieties (e.g., "PEGylated"
phospholipids such as polyethylene glycolated phospholipids).
[0796] 4) Low Molecular Weight Components
[0797] As indicated above, the molecular core of the self-reactive
compound can also be a low molecular weight compound, defined
herein as being a C.sub.2-14 hydrocarbyl or a heteroatom-containing
C.sub.2-14 hydrocarbyl, which contains 1 to 2 heteroatoms selected
from N, O, S and combinations thereof. Such a molecular core can be
substituted with any of the reactive groups described herein.
[0798] Alkanes are suitable C.sub.2-14 hydrocarbyl molecular cores.
Exemplary alkanes, for substituted with a nucleophilic primary
amino group and a Y electrophilic group, include, ethyleneamine
(H.sub.2N--CH.sub.2CH.sub.2--Y), tetramethyleneamine
(H.sub.2N--(CH.sub.4)--Y), pentamethyleneamine
(H.sub.2N--(CH.sub.5)--Y), and hexamethyleneamine
(H.sub.2N--(CH.sub.6)--Y).
[0799] Low molecular weight diols and polyols are also suitable
C.sub.2-14 hydrocarbyls and include trimethylolpropane,
di(trimethylol propane), pentaerythritol, and diglycerol. Polyacids
are also suitable C.sub.2-14 hydrocarbyls, and include
trimethylolpropane-based tricarboxylic acid, di(trimethylol
propane)-based tetracarboxylic acid, heptanedioic acid, octanedioic
acid (suberic acid), and hexadecanedioic acid (thapsic acid).
[0800] Low molecular weight di- and poly-electrophiles are suitable
heteroatom-containing C.sub.2-14 hydrocarbyl molecular cores. These
include, for example, disuccinimidyl suberate (DSS),
bis(sulfosuccinimidyl) suberate (BS.sub.3),
dithiobis(succinimidylpropion- ate) (DSP),
bis(2-succinimidooxycarbonyloxy) ethyl sulfone (BSOCOES), and
3,3'-dithiobis(sulfosuccinimidylpropionate (DTSPP), and their
analogs and derivatives.
[0801] In one embodiment of the invention, the self-reactive
compound of the invention comprises a low-molecular weight material
core, with a plurality of acrylate moieties and a plurality of
thiol groups.
[0802] H. Preparation
[0803] The self-reactive compounds are readily synthesized to
contain a hydrophilic, hydrophobic or amphiphilic polymer core or a
low molecular weight core, functionalized with the desired
functional groups, i.e., nucleophilic and electrophilic groups,
which enable crosslinking. For example, preparation of a
self-reactive compound having a polyethylene glycol (PEG) core is
discussed below. However, it is to be understood that the following
discussion is for purposes of illustration and analogous techniques
may be employed with other polymers.
[0804] With respect to PEG, first of all, various functionalized
PEGs have been used effectively in fields such as protein
modification (see Abuchowski et al., Enzymes as Drugs, John Wiley
& Sons: New York, N.Y. (1981) pp. 367-383; and Dreborg et al.
(1990) Crit. Rev. Therap. Drug Carrier Syst. 6:315), peptide
chemistry (see Mutter et al., The Peptides, Academic: New York,
N.Y. 2:285-332; and Zalipsky et al. (1987) Int. J. Peptide Protein
Res. 30:740), and the synthesis of polymeric drugs (see Zalipsky et
al. (1983) Eur. Polym. J. 19:1177; and Ouchi et al. (1987) J.
Macromol. Sci. Chem. A24:1011).
[0805] Functionalized forms of PEG, including multi-functionalized
PEG, are commercially available, and are also easily prepared using
known methods. For example, see Chapter 22 of Poly(ethylene Glycol)
Chemistry: Biotechnical and Biomedical Applications, J. Milton
Harris, ed., Plenum Press, NY (1992).
[0806] Multi-functionalized forms of PEG are of particular interest
and include, PEG succinimidyl glutarate, PEG succinimidyl
propionate, succinimidyl butylate, PEG succinimidyl acetate, PEG
succinimidyl succinamide, PEG succinimidyl carbonate, PEG
propionaldehyde, PEG glycidyl ether, PEG-isocyanate, and
PEG-vinylsulfone. Many such forms of PEG are described in U.S. Pat.
Nos. 5,328,955 and 6,534,591, both to Rhee et al. Similarly,
various forms of multi-amino PEG are commercially available from
sources such as PEG Shop, a division of SunBio of South Korea
(www.sunbio.com), Nippon Oil and Fats (Yebisu Garden Place Tower,
20-3 Ebisu 4-chome, Shibuya-ku, Tokyo), Nektar Therapeutics (San
Carlos, Calif., formerly Shearwater Polymers, Huntsville, Ala.) and
from Huntsman's Performance Chemicals Group (Houston, Tex.) under
the name Jeffamine.RTM. polyoxyalkyleneamines. Multi-amino PEGs
useful in the present invention include the Jeffamine diamines ("D"
series) and triamines ("T" series), which contain two and three
primary amino groups per molecule. Analogous poly(sulfhydryl) PEGs
are also available from Nektar Therapeutics, e.g., in the form of
pentaerythritol poly(ethylene glycol) ether tetra-sulfhydryl
(molecular weight 10,000). These multi-functionalized forms of PEG
can then be modified to include the other desired reactive
groups.
[0807] Reaction with succinimidyl groups to convert terminal
hydroxyl groups to reactive esters is one technique for preparing a
core with electrophilic groups. This core can then be modified
include nucleophilic groups such as primary amines, thiols, and
hydroxyl groups. Other agents to convert hydroxyl groups include
carbonyldiimidazole and sulfonyl chloride. However, as discussed
herein, a wide variety of electrophilic groups may be
advantageously employed for reaction with corresponding
nucleophilic groups. Examples of such electrophilic groups include
acid chloride groups; anhydrides, ketones, aldehydes, isocyanate,
isothiocyanate, epoxides, and olefins, including conjugated olefins
such as ethenesulfonyl (--SO.sub.2CH.dbd.CH.sub.2) and analogous
functional groups.
[0808] Other in situ Crosslinking Materials
[0809] Numerous other types of in situ forming materials have been
described which may be used in combination with an anti-scarring
agent in accordance with the invention. The in situ forming
material may be a biocompatible crosslinked polymer that is formed
from water soluble precursors having electrophilic and nucleophilic
groups capable of reacting and crosslinking in situ (see, e.g.,
U.S. Pat. No. 6,566,406). The in situ forming material may be
hydrogel that may be formed through a combination of physical and
chemical crosslinking processes, where physical crosslinking is
mediated by one or more natural or synthetic components that
stabilize the hydrogel-forming precursor solution at a deposition
site for a period of time sufficient for more resilient chemical
crosslinks to form (see, e.g., U.S. Pat. No. 6,818,018). The in
situ forming material may be formed upon exposure to an aqueous
fluid from a physiological environment from dry hydrogel precursors
(see, e.g., U.S. Pat. No. 6,703,047). The in situ forming material
may be a hydrogel matrix that provides controlled release of
relatively low molecular weight therapeutic species by first
dispersing or dissolving the therapeutic species within relatively
hydrophobic rate modifying agents to form a mixture; the mixture is
formed into microparticles that are dispersed within bioabsorbable
hydrogels, so as to release the water soluble therapeutic agents in
a controlled fashion (see, e.g., U.S. Pat. No. 6,632,457). The in
situ forming material may be a multi-component hydrogel system
(see, e.g., U.S. Pat. No. 6,379,373). The in situ forming material
may be a multi-arm block copolymer that includes a central core
molecule, such as a residue of a polyol, and at least three
copolymer arms covalently attached to the central core molecule,
each copolymer arm comprising an inner hydrophobic polymer segment
covalently attached to the central core molecule and an outer
hydrophilic polymer segment covalently attached to the hydrophobic
polymer segment, wherein the central core molecule and the
hydrophobic polymer segment define a hydrophobic core region (see,
e.g., U.S. Pat. No. 6,730,334). The in situ forming material may
include a gel-forming macromer that includes at least four
polymeric blocks, at least two of which are hydrophobic and at
least one of which is hydrophilic, and including a crosslinkable
group (see, e.g., U.S. Pat. No. 6,639,014). The in situ forming
material may be a water-soluble macromer that includes at least one
hydrolysable linkage formed from carbonate or dioxanone groups, at
least one water-soluble polymeric block, and at least one
polymerizable group (see, e.g., U.S. Pat. No. 6,177,095). The in
situ forming material may comprise polyoxyalkylene block copolymers
that form weak physical crosslinks to provide gels having a
paste-like consistency at physiological temperatures. (see, e.g.,
U.S. Pat. No. 4,911,926). The in situ forming material may be a
thermo-irreversible gel made from polyoxyalkylene polymers and
ionic polysaccharides (see, e.g., U.S. Pat. No. 5,126,141). The in
situ forming material may be a gel forming composition that
includes chitin derivatives (see, e.g., U.S. Pat. No. 5,093,319),
chitosan-coagulum (see, e.g., U.S. Pat. No. 4,532,134), or
hyaluronic acid (see, e.g., U.S. Pat. No. 4,141,973). The in situ
forming material may be an in situ modification of alginate (see,
e.g., U.S. Pat. No. 5,266,326). The in situ forming material may be
formed from ethylenically unsaturated water soluble macromers that
can be crosslinked in contact with tissues, cells, and bioactive
molecules to form gels (see, e.g., U.S. Pat. No. 5,573,934). The in
situ forming material may include urethane prepolymers used in
combination with an unsaturated cyano compound containing a cyano
group attached to a carbon atom, such as cyano(meth)acrylic acids
and esters thereof (see, e.g., U.S. Pat. No. 4,740,534). The in
situ forming material may be a biodegradable hydrogel that
polymerizes by a photoinitiated free radical polymerization from
water soluble macromers (see, e.g., U.S. Pat. No. 5,410,016). The
in situ forming material may be formed from a two component mixture
including a first part comprising a serum albumin protein in an
aqueous buffer having a pH in a range of about 8.0-11.0, and a
second part comprising a water-compatible or water-soluble
bifunctional crosslinking agent. (see, e.g., U.S. Pat. No.
5,583,114).
[0810] In another aspect, in situ forming materials that can be
used include those based on the crosslinking of proteins. For
example, the in situ forming material may be a biodegradable
hydrogel composed of a recombinant or natural human serum albumin
and poly(ethylene) glycol polymer solution whereby upon mixing the
solution cross-links to form a mechanical non-liquid covering
structure which acts as a sealant. See e.g., U.S. Pat. Nos.
6,458,147 and 6,371,975. The in situ forming material may be
composed of two separate mixtures based on fibrinogen and thrombin
which are dispensed together to form a biological adhesive when
intermixed either prior to or on the application site to form a
fibrin sealant. See e.g., U.S. Pat. No. 6,764,467. The in situ
forming material may be composed of ultrasonically treated collagen
and albumin which form a viscous material that develops adhesive
properties when crosslinked chemically with glutaraldehyde and
amino acids or peptides. See e.g., U.S. Pat. No. 6,310,036. The in
situ forming material may be a hydrated adhesive gel composed of an
aqueous solution consisting essentially of a protein having amino
groups at the side chains (e.g., gelatin, albumin) which is
crosslinked with an N-hydroxyimidoester compound. See e.g., U.S.
Pat. No. 4,839,345. The in situ forming material may be a hydrogel
prepared from a protein or polysaccharide backbone (e.g., albumin
or polymannuronic acid) bonded to a cross-linking agent (e.g.,
polyvalent derivatives of polyethylene or polyalkylene glycol). See
e.g., U.S. Pat. No. 5,514,379. The in situ forming material may be
composed of a polymerizable collagen composition that is applied to
the tissue and then exposed to an initiator to polymerize the
collagen to form a seal over a wound opening in the tissue. See
e.g., U.S. Pat. No. 5,874,537. The in situ forming material may be
a two component mixture composed of a protein (e.g., serum albumin)
in an aqueous buffer having a pH in the range of about 8.0-11.0 and
a water-soluble bifunctional polyethylene oxide type crosslinking
agent, which transforms from a liquid to a strong, flexible bonding
composition to seal tissue in situ. See e.g., U.S. Pat. Nos.
5,583,114 and RE38158 and PCT Publication No. WO 96/03159. The in
situ forming material may be composed of a protein, a surfactant,
and a lipid in a liquid carrier, which is crosslinked by adding a
crosslinker and used as a sealant or bonding agent in situ. See
e.g., U.S. patent application Ser. No. 2004/0063613A1 and PCT
Publication Nos. WO 01/45761 and WO 03/090683. The in situ forming
material may be composed of two enzyme-free liquid components that
are mixed by dispensing the components into a catheter tube
deployed at the vascular puncture site, wherein, upon mixing, the
two liquid components chemically cross-link to form a mechanical
non-liquid matrix that seals a vascular puncture site. See e.g.,
U.S. patent application Ser. Nos. 2002/0161399A1 and
2001/0018598A1. The in situ forming material may be a cross-linked
albumin composition composed of an albumin preparation and a
carbodiimide preparation which are mixed under conditions that
permit crosslinking of the albumin for use as a bioadhesive or
sealant. See e.g., PCT Publication No. WO 99/66964. The in situ
forming material may be composed of collagen and a peroxidase and
hydrogen peroxide, such that the collagen is crosslinked to from a
semi-solid gel that seals a wound. See e.g., PCT Publication No. WO
01/35882.
[0811] In another aspect, in situ forming materials that can be
used include those based on isocyanate or isothiocyanate capped
polymers. For example, the in situ forming material may be composed
of isocyanate-capped polymers that are liquid compositions which
form into a solid adhesive coating by in situ polymerization and
crosslinking upon contact with body fluid or tissue. See e.g., PCT
Publication No. WO 04/021983. The in situ forming material may be a
moisture-curing sealant composition composed of an active
isocyanato-terminated isocyanate prepolymer containing a polyol
component with a molecular weight of 2,000 to 20,000 and an
isocyanurating catalyst agent. See e.g., U.S. Pat. No.
5,206,331.
[0812] Representative examples of compositions that undergo
electrophilic-nucleophilic crosslinking reactions and methods of
preparing such compositions are described in U.S. Pat. Nos.
5,752,974; 5,807,581; 5,874,500; 5,936,035; 6,051,648; 6,165,489;
6,312,725; 6,458,889; 6,495,127; 6,534,591; 6,624,245; 6,566,406;
6,610,033; 6,632,457; U.S. patent application Publication No.
2003/0077272; and PCT Application Publication Nos. WO 04/060405 and
WO 04/060346. Other examples of in situ forming materials that can
be used include those based on the crosslinking of proteins
(described in U.S. Pat. Nos. RE38158; 4,839,345; 5,514,379,
5,583,114; 6,458,147; 6,371,975; U.S. patent application
Publication Nos. 2002/0161399; 2001/0018598 and PCT Publication
Nos. WO 03/090683; WO 01/45761; WO 99/66964 and WO 96/03159).
[0813] In another embodiment, the anti-fibrosing (or
gliosis-inhibiting) agent can be coated onto the entire device or a
portion of the device. In certain embodiments, the agent is present
as part of a coating on a surface of the CRM or neurostimulation
device, lead and/or electrode. The coating may partially cover or
may completely cover the surface of the electrical device, lead
and/or electrode. Further, the coating may directly or indirectly
contact the electrical device, lead and/or electrode. For example,
the CRM or neurostimulation device, lead and/or electrode may be
coated with a first coating and then coated with a second coating
that includes the anti-scarring (or gliosis-inhibiting) agent.
[0814] CRM and neurostimulation devices, leads and/or electrodes
may be coated using a variety of coating methods, including by
dipping, spraying, painting, by vacuum deposition, or by any other
method known to those of ordinary skill in the art.
[0815] As described above, the anti-fibrosing (or anti-gliotic)
agent can be coated onto the appropriate CRM or neurostimulation
device, lead and/or electrode using the polymeric coatings
described above. In addition to the coating compositions and
methods described above, there are various other coating
compositions and methods that are known in the art. Representative
examples of these coating compositions and methods are described in
U.S. Pat. Nos. 6,610,016; 6,358,557; 6,306,176; 6,110,483;
6,106,473; 5,997,517; 5,800,412; 5,525,348; 5,331,027; 5,001,009;
6,562,136; 6,406,754; 6,344,035; 6,254,921; 6,214,901; 6,077,698;
6,603,040; 6,278,018; 6,238,799; 6,096,726, 5,766,158, 5,599,576,
4,119,094; 4,100,309; 6,599,558; 6,369,168; 6,521,283; 6,497,916;
6,251,964; 6,225,431; 6,087,462; 6,083,257; 5,739,237; 5,739,236;
5,705,583; 5,648,442; 5,645,883; 5,556,710; 5,496,581; 4,689,386;
6,214,115; 6,090,901; 6,599,448; 6,054,504; 4,987,182; 4,847,324;
and 4,642,267; U.S. patent application Publication Nos.
2002/0146581, 2003/0129130, 2001/0026834; 2003/0190420;
2001/0000785; 2003/0059631; 2003/0190405; 2002/0146581;
2003/020399; 2001/0026834; 2003/0190420; 2001/0000785;
2003/0059631; 2003/0190405; and 2003/020399; and PCT Publication
Nos. WO 02/055121; WO 01/57048; WO 01/52915; and WO 01/01957.
[0816] In yet another aspect, anti-scarring (or anti-gliosis) agent
may be located within pores or voids of the electrical device, lead
and/or electrode. For example, a CRM or neurostimulation device,
lead and/or electrode may be constructed to have cavities (e.g.,
divets or holes), grooves, lumen(s), pores, channels, and the like,
which form voids or pores in the body of the device, lead and/or
electrode. These voids may be filled (partially or completely) with
a fibrosis-inhibiting (or gliosis-inhibiting) agent or a
composition that comprises a fibrosis-inhibiting (or
gliosis-inhibiting) agent.
[0817] Within another aspect of the invention, the biologically
active agent can be delivered with non-polymeric agents. These
non-polymeric agents can include sucrose derivatives (e.g., sucrose
acetate isobutyrate, sucrose oleate), sterols such as cholesterol,
stigmasterol, .beta.-sitosterol, and estradiol; cholesteryl esters
such as cholesteryl stearate; C.sub.12-C.sub.24 fatty acids such as
lauric acid, myristic acid, palmitic acid, stearic acid, arachidic
acid, behenic acid, and lignoceric acid; C.sub.18-C.sub.36 mono-,
di- and triacylglycerides such as glyceryl monooleate, glyceryl
monolinoleate, glyceryl monolaurate, glyceryl monodocosanoate,
glyceryl monomyristate, glyceryl monodicenoate, glyceryl
dipalmitate, glyceryl didocosanoate, glyceryl dimyristate, glyceryl
didecenoate, glyceryl tridocosanoate, glyceryl trimyristate,
glyceryl tridecenoate, glycerol tristearate and mixtures thereof;
sucrose fatty acid esters such as sucrose distearate and sucrose
palmitate; sorbitan fatty acid esters such as sorbitan
monostearate, sorbitan monopalmitate and sorbitan tristearate;
C.sub.16-C.sub.18 fatty alcohols such as cetyl alcohol, myristyl
alcohol, stearyl alcohol, and cetostearyl alcohol; esters of fatty
alcohols and fatty acids such as cetyl palmitate and cetearyl
palmitate; anhydrides of fatty acids such as stearic anhydride;
phospholipids including phosphatidylcholine (lecithin),
phosphatidylserine, phosphatidylethanolamine, phosphatidylinositol,
and lysoderivatives thereof; sphingosine and derivatives thereof;
spingomyelins such as stearyl, palmitoyl, and tricosanyl
spingomyelins; ceramides such as stearyl and palmitoyl ceramides;
glycosphingolipids; lanolin and lanolin alcohols, calcium
phosphate, sintered and unscintered hydoxyapatite, zeolites, and
combinations and mixtures thereof.
[0818] Representative examples of patents relating to non-polymeric
delivery systems and their preparation include U.S. Pat. Nos.
5,736,152;
[0819] 5,888,533; 6,120,789; 5,968,542; and 5,747,058.
[0820] The fibrosis-inhibiting (or gliosis-inhibiting) agent may be
delivered as a solution. The fibrosis-inhibiting (or
gliosis-inhibiting) agent can be incorporated directly into the
solution to provide a homogeneous solution or dispersion. In
certain embodiments, the solution is an aqueous solution. The
aqueous solution may futher include buffer salts, as well as
viscosity modifying agents (e.g., hyaluronic acid, alginates, CMC,
and the like). In another aspect of the invention, the solution can
include a biocompatible solvent, such as ethanol, DMSO, glycerol,
PEG-200, PEG-300 or NMP.
[0821] Within another aspect of the invention, the
fibrosis-inhibiting (or gliosis-inhibiting) agent can further
comprise a secondary carrier. The secondary carrier can be in the
form of microspheres (e.g., PLGA, PLLA, PDLLA, PCL, gelatin,
polydioxanone, poly(alkylcyanoacrylate), nanospheres (e.g., PLGA,
PLLA, 20 PDLLA, PCL, gelatin, polydioxanone,
poly(alkylcyanoacrylate)), liposomes, emulsions, microemulsions,
micelles (e.g., SDS, block copolymers of the form X--Y, X--Y--X or
Y--X--Y where X is a poly(alkylene oxide) or alkyl ether thereof
(e.g., poly(ethylene glycol), methoxy poly(ethylene glycol),
poly(propylene glycol), block copolymers of poly(ethylene oxide)
and poly(propylene oxide) [e.g., PLURONIC and PLURONIC R polymers
(BASF)]) and Y is a polyester where the polyester can comprise the
residues of one or more of the monomers selected from lactide,
lactic acid, glycolide, glycolic acid, e-caprolactone,
gamma-caprolactone, hydroxyvaleric acid, hydroxybutyric acid,
beta-butyrolactone, gamma-butyrolactone, gamma-valerolactone,
.gamma.-decanolactone, .delta.-decanolactone, trimethylene
carbonate, 1,4-dioxane-2-one or 1,5-dioxepan-2one (e.g., PLGA,
PLLA, PDLLA, PCL polydioxanone)), zeolites or cyclodextrins.
[0822] Within another aspect of the invention, these
fibrosis-inhibiting (or gliosis-inhibiting) agent/secondary carrier
compositions can be a) incorporated directly into, or onto, the CRM
or neurostimulation device, lead and/or electrode, b) incorporated
into a solution, c) incorporated into a gel or viscous solution, d)
incorporated into the composition used for coating the device, lead
and/or electrode, or e) incorporated into, or onto, the device,
lead and/or electrode following coating of the device, lead and/or
electrode with a coating composition.
[0823] For example, fibrosis-inhibiting (or gliosis-inhibiting)
agent loaded PLGA microspheres may be incorporated into a
polyurethane coating solution which is then coated onto the device,
lead and/or electrode.
[0824] In yet another example, the device, lead and/or electrode
can be coated with a polyurethane and then allowed to partially dry
such that the surface is still tacky. A particulate form of the
fibrosis-inhibiting (or gliosis-inhibiting) agent or
fibrosis-inhibiting (or gliosis-inhibiting) agent/secondary carrier
can then be applied to all or a portion of the tacky coating after
which the device is dried.
[0825] In yet another example, the device, lead and/or electrode
can be coated with one of the coatings described above. A thermal
treatment process can then be used to soften the coating, after
which the fibrosis-inhibiting (or gliosis-inhibiting) agent or the
fibrosis-inhibiting (or gliosis-inhibiting) agent/secondary carrier
is applied to the entire device, lead and/or electrode or to a
portion of the device, lead and/or electrode (e.g., outer
surface).
[0826] Within another aspect of the invention, the coated CRM or
neurostimulation device, lead and/or electrode which inhibits or
reduces an in vivo fibrotic (or gliotic) reaction is further coated
with a compound or compositions which delay the release of and/or
activity of the fibrosis-inhibiting (or gliosis-inhibiting) agent.
Representative examples of such agents include biologically inert
materials such as gelatin, PLGA/MePEG film, PLA, polyurethanes,
silicone rubbers, surfactants, lipids, or polyethylene glycol, as
well as biologically active materials such as heparin or heparin
quaternary amine complexes (e.g., heparin-benzalkonium chloride
complex) (e.g., to induce coagulation).
[0827] For example, in one embodiment of the invention the active
agent on the device, lead and/or electrode is top-coated with a
physical barrier. Such barriers can include non-degradable
materials or biodegradable materials such as gelatin, PLGA/MePEG
film, PLA, or polyethylene glycol among others. In one embodiment,
the rate of diffusion of the therapeutic agent in the barrier coat
is slower that the rate of diffusion of the therapeutic agent in
the coating layer. In the case of PLGA/ MePEG, once the PLGA/ MePEG
becomes exposed to the blood or body fluids, the MePEG may dissolve
out of the PLGA, leaving channels through the PLGA to an underlying
layer containing the fibrosis-inhibiting (or gliosis-inhibiting)
agent, which then can then diffuse into the tissue and initiate its
biological activity.
[0828] In another embodiment of the invention, for example, a
particulate form of the active agent may be coated onto the CRM or
neurostimulation device, lead and/or electrode using a polymer
(e.g., PLG, PLA, polyurethane). A second polymer that dissolves
slowly or degrades (e.g., MePEG-PLGA or PLG) and that does not
contain the active agent may be coated over the first layer. Once
the top layer dissolves or degrades, it exposes the under coating
which allows the active agent to be exposed to the treatment site
or to be released from the coating.
[0829] Within another aspect of the invention, the outer layer of
the coating of a coated CRM or neurostimulation device, lead and/or
electrode which inhibits an in vivo fibrotic (or gliotic) response
is further treated to crosslink the outer layer of the coating.
This can be accomplished by subjecting the coated device, lead
and/or electrode to a plasma treatment process. The degree of
crosslinking and nature of the surface modification can be altered
by changing the RF power setting, the location with respect to the
plasma, the duration of treatment as well as the gas composition
introduced into the plasma chamber.
[0830] Protection of a biologically active surface can also be
utilized by coating the CRM or neurostimulator device, lead and/or
electrode surface with an inert molecule that prevents access to
the active site through steric hindrance, or by coating the surface
with an inactive form of the fibrosis-inhibiting (or
gliosis-inhibiting) agent, which is later activated. For example,
the device, lead and/or electrode can be coated with an enzyme,
which causes either release of the fibrosis-inhibiting (or
gliosis-inhibiting) agent or activates the fibrosis-inhibiting (or
gliosis-inhibiting) agent.
[0831] Another example of a suitable CRM or neurostimulation
device, lead and/or electrode surface coating includes an
anticoagulant such as heparin or heparin quaternary amine complexes
(e.g., heparin-benzalkonium chloride complex), which can be coated
on top of the fibrosis-inhibiting (or gliosis-inhibiting) agent;
this may also be useful during transvenous placement of pacemaker
or ICD leads to prevent clotting. The presence of the anticoagulant
delays coagulation. As the anticoagulant dissolves away, the
anticoagulant activity may stop, and the newly exposed
fibrosis-inhibiting (or gliosis-inhibiting) agent may inhibit or
reduce fibrosis (or gliosis) from occurring in the adjacent tissue
or coating the device, lead and/or electrode.
[0832] In another aspect, the CRM or neurostimulation device, lead
and/or electrode can be coated with an inactive form of the
fibrosis-inhibiting (or gliosis-inhibiting) agent, which is then
activated once the device is deployed. Such activation may be
achieved by injecting another material into the treatment area
after the device, lead and/or electrode (as described below) is
implanted or after the fibrosis-inhibiting (or gliosis-inhibiting)
agent has been administered to the treatment area (via injections,
spray, wash, drug delivery catheters or balloons). In this aspect,
the device, lead and/or electrode may be coated with an inactive
form of the fibrosis-inhibiting (or gliosis-inhibiting) agent. Once
the device, lead and/or electrode is implanted, the activating
substance is injected or applied into, or onto, the treatment site
where the inactive form of the fibrosis-inhibiting (or
gliosis-inhibiting) agent has been applied.
[0833] One example of this method includes coating a CRM or
neurostimulation device, lead and/or electrode with a biologically
active fibrosis-(or gliosis-inhibiting) inhibiting agent, as
described herein as described herein. The coating containing the
active fibrosis-inhibiting (or gliosis-inhibiting) agent may then
be covered with polyethylene glycol and these two substances may
then be bonded through an ester bond using a condensation reaction.
Prior to the deployment of the device, lead and/or electrode, an
esterase is injected into the tissue around the outside of the
device (lead or electrode), which can cleave the bond between the
ester and the fibrosis-inhibiting (or gliosis-inhibiting)
therapeutic agent, allowing the agent to initiate fibrosis (or
gliosis) inhibition.
[0834] The devices and compositions of the invention may include
one or more additional ingredients and/or therapeutic agents, such
as surfactants (e.g., PLURONICS, such as F-127, L-122, L-101, L-92,
L-81, and L-61), anti-inflammatory agents (e.g., dexamethasone or
aspirin), anti-thrombotic agents (e.g., heparin, high activity
heparin, heparin quaternary amine complexes (e.g., heparin
benzalkonium chloride complex)), anti-infective agents (e.g.,
5-fluorouracil, triclosan, rifamycim, and silver compounds),
preservatives, anti-oxidants and/ or anti-platelet agents.
[0835] Within certain embodiments of the invention, the device or
therapeutic composition can also comprise radio-opaque, echogenic
materials and magnetic resonance imaging (MRI) responsive materials
(i.e., MRI contrast agents) to aid in visualization of the
composition under ultrasound, fluoroscopy and/or MRI. For example,
a composition may be echogenic or radiopaque (e.g., made with
echogenic or radiopaque with materials such as powdered tantalum,
tungsten, barium carbonate, bismuth oxide, barium sulfate,
metrazimide, iopamidol, iohexol, iopromide, iobitridol, iomeprol,
iopentol, ioversol, ioxilan, iodixanol, iotrolan, acetrizoic acid
derivatives, diatrizoic acid derivatives, iothalamic acid
derivatives, ioxithalamic acid derivatives, metrizoic acid
derivatives, iodamide, lypophylic agents, iodipamide and ioglycamic
acid or, by the addition of microspheres or bubbles which present
an acoustic interface). For visualization under MRI, contrast
agents (e.g., gadolinium (III) chelates or iron oxide compounds)
may be incorporated into the composition. In some embodiments, a
medical device may include radio-opaque or MRI visible markers
(e.g., bands) that may be used to orient and guide the device
during the implantation procedure.
[0836] The devices may, alternatively, or in addition, be
visualized under visible light, using fluorescence, or by other
spectroscopic means. Visualization agents that can be included for
this purpose include dyes, pigments, and other colored agents. In
one aspect, the composition may further include a colorant to
improve visualization of the composition in vivo and/or ex vivo.
Frequently, compositions can be difficult to visualize upon
delivery into a host, especially at the margins of an implant or
tissue. A coloring agent can be incorporated into a composition to
reduce or eliminate the incidence or severity of this problem. The
coloring agent provides a unique color, increased contrast, or
unique fluorescence characteristics to the composition. In one
aspect, a composition is provided that includes a colorant such
that it is readily visible (under visible light or using a
fluorescence technique) and easily differentiated from its implant
site. In another aspect, a colorant can be included in a liquid or
semi-solid composition. For example, a single component of a two
component mixture may be colored, such that when combined ex-vivo
or in-vivo, the mixture is sufficiently colored.
[0837] The coloring agent may be, for example, an endogenous
compound (e.g., an amino acid or vitamin) or a nutrient or food
material and may be a hydrophobic or a hydrophilic compound.
Preferably, the colorant has a very low or no toxicity at the
concentration used. Also preferred are colorants that are safe and
normally enter the body through absorption such as .beta.-carotene.
Representative examples of colored nutrients (under visible light)
include fat soluble vitamins such as Vitamin A (yellow); water
soluble vitamins such as Vitamin B12 (pink-red) and folic acid
(yellow-orange); carotenoids such as .beta.-carotene
(yellow-purple) and lycopene (red). Other examples of coloring
agents include natural product (berry and fruit) extracts such as
anthrocyanin (purple) and saffron extract (dark red). The coloring
agent may be a fluorescent or phosphorescent compound such as
.alpha.-tocopherolquinol (a Vitamin E derivative) or
L-tryptophan.
[0838] In one aspect, the devices and compositions of the present
invention include one or more coloring agents, also referred to as
dyestuffs, which may be present in an effective amount to impart
observable coloration to the composition, e.g., the gel. Examples
of coloring agents include dyes suitable for food such as those
known as F. D. & C. dyes and natural coloring agents such as
grape skin extract, beet red powder, beta carotene, annato,
carmine, turmeric, paprika, and so forth. Derivatives, analogues,
and isomers of any of the above colored compound also may be used.
The method for incorporating a colorant into an implant or
therapeutic composition may be varied depending on the properties
of and the desired location for the colorant. For example, a
hydrophobic colorant may be selected for hydrophobic matrices. The
colorant may be incorporated into a carrier matrix, such as
micelles. Further, the pH of the environment may be controlled to
further control the color and intensity.
[0839] In one aspect, the devices compositions of the present
invention include one or more preservatives or bacteriostatic
agents present in an effective amount to preserve the composition
and/or inhibit bacterial growth in the composition, for example,
bismuth tribromophenate, methyl hydroxybenzoate, bacitracin, ethyl
hydroxybenzoate, propyl hydroxybenzoate, erythromycin,
chlorocresol, benzalkonium chlorides, and the like. Examples of the
preservative include paraoxybenzoic acid esters, chlorobutanol,
benzylalcohol, phenethyl alcohol, dehydroacetic acid, sorbic acid,
etc. In one aspect, the compositions of the present invention
include one or more bactericidal (also known as bacteriacidal)
agents.
[0840] In one aspect, the devices and compositions of the present
invention include one or more antioxidants, present in an effective
amount. Examples of the antioxidant include sulfites,
alpha-tocopherol and ascorbic acid.
[0841] Within certain aspects of the present invention, the
therapeutic composition should be biocompatible, and release one or
more fibrosis-inhibiting agents over a period of several hours,
days, or, months. As described above, "release of an agent" refers
to any statistically significant presence of the agent, or a
subcomponent thereof, which has disassociated from the compositions
and/or remains active on the surface of (or within) the
composition. The compositions of the present invention may release
the anti-scarring agent at one or more phases, the one or more
phases having similar or different performance (e.g., release)
profiles. The therapeutic agent may be made available to the tissue
at amounts which may be sustainable, intermittent, or continuous;
in one or more phases; and/or rates of delivery; effective to
reduce or inhibit any one or more components of fibrosis (or
scarring) (or gliosis), including: formation of new blood vessels
(angiogenesis), migration and proliferation of connective tissue
cells (such as fibroblasts or smooth muscle cells), deposition of
extracellular matrix (ECM), and remodeling (maturation and
organization of the fibrous tissue).
[0842] Thus, release rate may be programmed to impact fibrosis (or
scarring) by releasing an anti-scarring agent at a time such that
at least one of the components of fibrosis (or gliosis) is
inhibited or reduced. Moreover, the predetermined release rate may
reduce agent loading and/or concentration as well as potentially
providing minimal drug washout and thus, increases efficiency of
drug effect. Any one of the anti-scarring agents described herein
may perform one or more functions, including inhibiting the
formation of new blood vessels (angiogenesis), inhibiting the
migration and proliferation of connective tissue cells (such as
fibroblasts or smooth muscle cells), inhibiting the deposition of
extracellular matrix (ECM), and inhibiting remodeling (maturation
and organization of the fibrous tissue). In one embodiment, the
rate of release may provide a sustainable level of the
anti-scarring agent to the susceptible tissue site. In another
embodiment, the rate of release is substantially constant. The rate
may decrease and/or increase over time, and it may optionally
include a substantially non-release period. The release rate may
comprise a plurality of rates. In an embodiment, the plurality of
release rates may include rates selected from the group consisting
of substantially constant, decreasing, increasing, and
substantially non-releasing.
[0843] The total amount of anti-scarring agent made available on,
in or near the device may be in an amount ranging from about 0.01
.mu.g (micrograms) to about 2500 mg (milligrams). Generally, the
anti-scarring agent may be in the amount ranging from 0.01 .mu.g to
about 10 .mu.g; or from 10 .mu.g to about 1 mg; or from 1 mg to
about 10 mg; or from 10 mg to about 100 mg; or from 100 mg to about
500 mg; or from 500 mg to about 2500 mg.
[0844] The surface amount of anti-scarring agent on, in or near the
device may be in an amount ranging from less than 0.01 .mu.g to
about 250 .mu.g per mm.sup.2 of device surface area. Generally, the
anti-scarring agent may be in the amount ranging from less than
0.01 .mu.g per mm.sup.2; or from 0.01 .mu.g to about 10 .mu.g per
mm.sup.2; or from 10 .mu.g to about 250 .mu.g per mm.sup.2.
[0845] The anti-scarring agent that is on, in or near the device
may be released from the composition in a time period that may be
measured from the time of implantation, which ranges from about
less than 1 day to about 180 days. Generally, the release time may
also be from about less than 1 day to about 7 days; from 7 days to
about 14 days; from 14 days to about 28 days; from 28 days to about
56 days; from 56 days to about 90 days; from 90 days to about 180
days.
[0846] The amount of anti-scarring agent released from the
composition as a function of time may be determined based on the in
vitro release characteristics of the agent from the composition.
The in vitro release rate may be determined by placing the
anti-scarring agent within the composition or device in an
appropriate buffer such as 0.1M phosphate buffer (pH 7.4)) at
37.degree. C. Samples of the buffer solution are then periodically
removed for analysis by HPLC, and the buffer is replaced to avoid
any saturation effects.
[0847] Based on the in vitro release rates, the release of
anti-scarring agent per day may range from an amount ranging from
about 0.01 .mu.g (micrograms) to about 2500 mg (milligrams).
Generally, the anti-scarring agent that may be released in a day
may be in the amount ranging from 0.01 .mu.g to about 10 .mu.g; or
from 10 .mu.g to about 1 mg; or from 1 mg to about 10 mg; or from
10 mg to about 100 mg; or from 100 mg to about 500 mg; or from 500
mg to about 2500 mg.
[0848] In one embodiment, the anti-scarring agent is made available
to the susceptible tissue site in a programmed, sustained, and/or
controlled manner which results in increased efficiency and/or
efficacy. Further, the release rates may vary during either or both
of the initial and subsequent release phases. There may also be
additional phase(s) for release of the same substance(s) and/or
different substance(s).
[0849] Further, therapeutic compositions and devices of the present
invention should preferably have a stable shelf-life of at least
several months and be capable of being produced and maintained
under sterile conditions. Many pharmaceuticals are manufactured to
be sterile and this criterion is defined by the USP XXII
<1211>. The term "USP" refers to U.S. Pharmacopeia (see
www.usp.org, Rockville, Md.). Sterilization may be accomplished by
a number of means accepted in the industry and listed in the USP
XXII <1211>, including gas sterilization, ionizing radiation
or, when appropriate, filtration. Sterilization may be maintained
by what is termed asceptic processing, defined also in USP XXII
<1211>. Acceptable gases used for gas sterilization include
ethylene oxide. Acceptable radiation types used for ionizing
radiation methods include gamma, for instance from a cobalt 60
source and electron beam. A typical dose of gamma radiation is 2.5
MRad. Filtration may be accomplished using a filter with suitable
pore size, for example 0.22 .mu.m and of a suitable material, for
instance polytetrafluoroethylene (e.g., TEFLON from E.I. DuPont De
Nemours and Company, Wilmington, Del.).
[0850] In another aspect, the compositions and devices of the
present invention are contained in a container that allows them to
be used for their intended purpose, i.e., as a pharmaceutical
composition. Properties of the container that are important are a
volume of empty space to allow for the addition of a constitution
medium, such as water or other aqueous medium, e.g., saline,
acceptable light transmission characteristics in order to prevent
light energy from damaging the composition in the container (refer
to USP XXII <661>), an acceptable limit of extractables
within the container material (refer to USP XXII), an acceptable
barrier capacity for moisture (refer to USP XXII <671>) or
oxygen. In the case of oxygen penetration, this may be controlled
by including in the container, a positive pressure of an inert gas,
such as high purity nitrogen, or a noble gas, such as argon.
[0851] Typical materials used to make containers for
pharmaceuticals include USP Type I through III and Type NP glass
(refer to USP XXII <661>), polyethylene, TEFLON, silicone,
and gray-butyl rubber.
[0852] In one embodiment, the product containers can be
thermoformed plastics. In another embodiment, a secondary package
can be used for the product. In another embodiment, product can be
in a sterile container that is placed in a box that is labeled to
describe the contents of the box.
[0853] 1) Coating of CRM or Neurostimulation Devices, Leads and
Electrodes with Fibrosis-Inhibiting (or Gliosis-Inhibiting)
Agents
[0854] As described above, a range of polymeric and non-polymeric
materials can be used to incorporate the fibrosis-inhibiting (or
gliosis-inhibiting) agent onto or into an electrical device, lead
or electrode. Coating the device, lead and/or electrode with these
fibrosis-inhibiting (or gliosis-inhibiting) agent-containing
compositions, or with the fibrosis-inhibiting (or
gliosis-inhibiting) agent only, is one process that can be used to
incorporate the fibrosis-inhibiting (or gliosis-inhibiting) agent
into or onto the device, lead and/or electrode.
[0855] a) Dip Coating
[0856] Dip coating is an example of coating process that can be
used to associate the anti-scarring (or gliosis-inhibiting) agent
with the device, lead and/or electrode. In one embodiment, the
fibrosis-inhibiting (or gliosis-inhibiting) agent is dissolved in a
solvent for the fibrosis-inhibiting (or gliosis-inhibiting) agent
and is then coated onto the device, lead and/or electrode.
[0857] Fibrosis-Inhibiting (or Gliosis-Inhibiting) Agent with an
Inert Solvent
[0858] In one embodiment, the solvent is an inert solvent for the
device, lead or electrode such that the solvent does not dissolve
the medical device, lead or electrode to any great extent and is
not absorbed by the device, lead or electrode to any great extent.
The device, lead or electrode can be immersed, either partially or
completely, in the fibrosis-inhibiting (or gliosis-inhibiting)
agent/solvent solution for a specific period of time. The rate of
immersion into the fibrosis-inhibiting (or gliosis-inhibiting)
agent/solvent solution can be altered (e.g., 0.001 cm per sec to 50
cm per sec). The device, lead and/or electrode can then be removed
from the solution. The rate at which the device, lead or electrode
is withdrawn from the solution can be altered (e.g., 0.001 cm per
sec to 50 cm per sec). The coated device, lead or electrode can be
air-dried. The dipping process can be repeated one or more times
depending on the specific application, where higher repetitions
generally increase the amount of agent that is coated onto the
device, lead or electrode. The device, lead or electrode can be
dried under vacuum to reduce residual solvent levels. This process
may result in the fibrosis-inhibiting (or gliosis-inhibiting) agent
being coated on the surface of the device.
[0859] Fibrosis-Inhibiting (or Gliosis-Inhibiting) Agent with a
Swelling Solvent
[0860] In one embodiment, the solvent is one that will not dissolve
the CRM or neurostimulation device, lead or electrode but will be
absorbed by the device, lead or electrode. In certain cases, these
solvents can swell the device, lead or electrode to some extent.
The device, lead or electrode can be immersed, either partially or
completely, in the fibrosis-inhibiting (or gliosis-inhibiting)
agent/solvent solution for a specific period of time (seconds to
days). The rate of immersion into the fibrosis-inhibiting (or
gliosis-inhibiting) agent/solvent solution can be altered (e.g.,
0.001 cm per sec to 50 cm per sec). The device, lead and/or
electrode can then be removed from the solution. The rate at which
the device, lead or electrode is withdrawn from the solution can be
altered (e.g., 0.001 cm per sec to 50 cm per sec). The coated
device, lead or electrode can be air-dried. The dipping process can
be repeated one or more times depending on the specific
application. The device, lead or electrode can be dried under
vacuum to reduce residual solvent levels. This process results in
the fibrosis-inhibiting (or gliosis-inhibiting) agent being
adsorbed into the CRM or neurostimulation device, lead or
electrode. The fibrosis-inhibiting (or gliosis-inhibiting) agent
may also be present on the surface of the device, lead and/or
electrode. The amount of surface associated fibrosis-inhibiting (or
gliosis-inhibiting) agent may be reduced by dipping the coated
device, lead or electrode into a solvent for the
fibrosis-inhibiting (or gliosis-inhibiting) agent, or by spraying
the coated device, lead or electrode with a solvent for the
fibrosis-inhibiting (or gliosis-inhibiting) agent.
[0861] Fibrosis-Inhibiting (or Gliosis-Inhibiting) Agent with a
Solvent
[0862] In one embodiment, the solvent is one that may be absorbed
by the device, lead or electrode and that will dissolve the device,
lead or electrode. The device, lead or electrode can be immersed,
either partially or completely, in the fibrosis-inhibiting (or
gliosis-inhibiting) agent/solvent solution for a specific period of
time (seconds to hours). The rate of immersion into the
fibrosis-inhibiting (or gliosis-inhibiting) agent/solvent solution
can be altered (e.g., 0.001 cm per sec to 50 cm per sec). The
device, lead or electrode can then be removed from the solution.
The rate at which the device, lead or electrode is withdrawn from
the solution can be altered (e.g., 0.001 cm per sec to 50 cm per
sec). The coated device, lead or electrode can be air-dried. The
dipping process can be repeated one or more times depending on the
specific application. The device, lead or electrode can be dried
under vacuum to reduce residual solvent levels. This process will
result in the fibrosis-inhibiting (or gliosis-inhibiting) agent
being adsorbed into the medical device, lead or electrode as well
as being surface associated. The exposure time of the device, lead
or electrode to the solvent should not incur significant permanent
dimensional changes to the device, lead or electrode. The
fibrosis-inhibiting (or gliosis-inhibiting) agent may also be
present on the surface of the device, lead or electrode. The amount
of surface associated fibrosis-inhibiting (or gliosis-inhibiting)
agent may be reduced by dipping the coated device, lead or
electrode into a solvent for the fibrosis-inhibiting (or
gliosis-inhibiting) agent or by spraying the coated device, lead or
electrode with a solvent for the fibrosis-inhibiting (or
gliosis-inhibiting) agent.
[0863] In one embodiment, the fibrosis-inhibiting (or
gliosis-inhibiting) agent and a polymer are dissolved in a solvent,
for both the polymer and the fibrosis-inhibiting (or
gliosis-inhibiting) agent, and are then coated onto the device,
lead or electrode.
[0864] In the above description the device, lead or electrode can
be one that has not been modified or one that has been further
modified by coating with a polymer, surface treated by plasma
treatment, flame treatment, corona treatment, surface oxidation or
reduction, surface etching, mechanical smoothing or roughening, or
grafting prior to the coating process.
[0865] In any one the above dip coating methods, the surface of the
device, lead or electrode can be treated with a plasma
polymerization method prior to coating of the fibrosis-inhibiting
(or gliosis-inhibiting) agent or fibrosis-inhibiting (or
gliosis-inhibiting) agent-containing composition, such that a thin
polymeric layer is deposited onto the device, lead or electrode
surface. Examples of such methods include parylene coating of
devices and the use of various monomers such hydrocyclosiloxane
monomers. Parylene coating may be especially advantageous if the
device, or portions of the device (such as the lead or the
electrode), are composed of materials (e.g., stainless steel,
nitinol) that do not allow incorporation of the therapeutic
agent(s) into the surface layer using one of the above methods. A
parylene primer layer may be deposited onto the electrical device,
lead or electrode using a parylene coater (e.g., PDS 2010
LABCOATER2 from Cookson Electronics) and a suitable reagent (e.g.,
di-p-xylylene or dichloro-di-p-xylylene) as the coating feed
material. Parylene compounds are commercially available, for
example, from Specialty Coating Systems, Indianapolis, Ind.),
including PARYLENE N (di-p-xylylene), PARYLENE C (a monchlorinated
derivative of PARYLENE N, and Parylene D, a dichlorinated
derivative of PARYLENE N).
[0866] b) Spray Coating CRM and Neurostimulation Devices, Leads and
Electrodes
[0867] Spray coating is another coating process that can be used.
In the spray coating process, a solution or suspension of the
fibrosis-inhibiting (or gliosis-inhibiting) agent, with or without
a polymeric or non-polymeric carrier, is nebulized and directed to
the device, lead and/or electrode to be coated by a stream of gas.
One can use spray devices such as an air-brush (for example models
2020, 360, 175, 100, 200, 150, 350, 250, 400, 3000, 4000, 5000,
6000 from Badger Air-brush Company, Franklin Park, Ill.), spray
painting equipment, TLC reagent sprayers (for example Part # 14545
and 14654, Alltech Associates, Inc. Deerfield, Ill., and ultrasonic
spray devices (for example those available from Sono-Tek, Milton,
N.Y.). One can also use powder sprayers and electrostatic
sprayers.
[0868] In one embodiment, the fibrosis-inhibiting (or
gliosis-inhibiting) agent is dissolved in a solvent for the
fibrosis agent and is then sprayed onto the device, lead and/or
electrode.
[0869] Fibrosis-Inhibiting (or Gliosis-Inhibiting) Agent with an
Inert Solvent
[0870] In one embodiment, the solvent is an inert solvent for the
device, lead or electrode such that the solvent does not dissolve
the medical device, lead or electrode to any great extent and is
not absorbed to any great extent. The device, lead or electrode can
be held in place or mounted onto a mandrel or rod that has the
ability to move in an X, Y or Z plane or a combination of these
planes. Using one of the above described spray devices, the device,
lead or electrode can be spray coated such that it is either
partially or completely coated with the fibrosis-inhibiting (or
gliosis-inhibiting) agent/solvent solution. The rate of spraying of
the fibrosis-inhibiting (or gliosis-inhibiting) agent/solvent
solution can be altered (e.g., 0.001 mL per sec to 10 mL per sec)
to ensure that a good coating of the fibrosis-inhibiting (or
gliosis-inhibiting) agent is obtained. The coated device, lead or
electrode can be air-dried. The spray coating process can be
repeated one or more times depending on the specific application.
The device, lead or electrode can be dried under vacuum to reduce
residual solvent levels. This process results in the
fibrosis-inhibiting (or gliosis-inhibiting) agent being coated on
the surface of the device, lead and/or electrode.
[0871] Fibrosis-Inhibiting (or Gliosis-Inhibiting) Agent with a
Swelling Solvent
[0872] In one embodiment, the solvent is one that will not dissolve
the device, lead or electrode but will be absorbed by it. These
solvents can thus swell the device, lead or electrode to some
extent. The device, lead or electrode can be spray coated, either
partially or completely, in the fibrosis-inhibiting (or
gliosis-inhibiting) agent/solvent solution. The rate of spraying of
the fibrosis-inhibiting (or gliosis-inhibiting) agent/solvent
solution can be altered (e.g., 0.001 mL per sec to 10 mL per sec)
to ensure that a good coating of the fibrosis-inhibiting (or
gliosis-inhibiting) agent is obtained. The coated device, lead or
electrode can be air-dried. The spray coating process can be
repeated one or more times depending on the specific application.
The device, lead or electrode can be dried under vacuum to reduce
residual solvent levels. This process can result in the
fibrosis-inhibiting (or gliosis-inhibiting) agent being adsorbed
into the medical device, lead or electrode. The fibrosis-inhibiting
(or gliosis-inhibiting) agent may also be present on the surface of
the device, lead or electrode. The amount of surface associated
fibrosis-inhibiting (or gliosis-inhibiting) agent may be reduced by
dipping the coated device, lead or electrode into a solvent for the
fibrosis-inhibiting (or gliosis-inhibiting) agent, or by spraying
the coated device, lead or electrode with a solvent for the
fibrosis-inhibiting (or gliosis-inhibiting) agent.
[0873] Fibrosis-Inhibiting (or Gliosis-Inhibiting) Agent with a
Solvent
[0874] In one embodiment, the solvent is one that will be absorbed
by the device, lead or electrode and that will dissolve it. The
device, lead or electrode can be spray coated, either partially or
completely, in the fibrosis-inhibiting (or gliosis-inhibiting)
agent/solvent solution. The rate of spraying of the
fibrosis-inhibiting (or gliosis-inhibiting) agent/solvent solution
can be altered (e.g., 0.001 mL per sec to 10 mL per sec) to ensure
that a good coating of the fibrosis-inhibiting (or
gliosis-inhibiting) agent is obtained. The coated device, lead or
electrode can be air-dried. The spray coating process can be
repeated one or more times depending on the specific application.
The device, lead or electrode can be dried under vacuum to reduce
residual solvent levels. This process will result in the
fibrosis-inhibiting (or gliosis-inhibiting) agent being adsorbed
into the medical device, lead or electrode as well as being surface
associated. In one embodiment, the exposure time of the device,
lead or electrode to the solvent may not incur significant
permanent dimensional changes to it. The fibrosis-inhibiting (or
gliosis-inhibiting) agent may also be present on the surface of the
device, lead or electrode. The amount of surface associated
fibrosis-inhibiting (or gliosis-inhibiting) agent may be reduced by
dipping the coated device, lead or electrode into a solvent for the
fibrosis-inhibiting (or gliosis-inhibiting) agent, or by spraying
the coated device, lead or electrode with a solvent for the
fibrosis-inhibiting (or gliosis-inhibiting) agent.
[0875] In the above description the device, lead or electrode can
be one that has not been modified as well as one that has been
further modified by coating with a polymer (e.g., parylene),
surface treated by plasma treatment, flame treatment, corona
treatment, surface oxidation or reduction, surface etching,
mechanical smoothing or roughening, or grafting prior to the
coating process.
[0876] In one embodiment, the fibrosis-inhibiting (or
gliosis-inhibiting) agent and a polymer are dissolved in a solvent,
for both the polymer and the anti-fibrosing (or gliosis-inhibiting)
agent, and are then spray coated onto the device, lead or
electrode.
[0877] Fibrosis-Inhibiting (or Gliosis-Inhibiting) Agent/Polymer
with an Inert Solvent
[0878] In one embodiment, the solvent is an inert solvent for the
device, lead or electrode such that the solvent does not dissolve
it to any great extent and is not absorbed by it to any great
extent. The device, lead or electrode can be spray coated, either
partially or completely, in the fibrosis-inhibiting (or
gliosis-inhibiting) agent/polymer/solvent solution for a specific
period of time. The rate of spraying of the fibrosis-inhibiting (or
gliosis-inhibiting) agent/solvent solution can be altered (e.g.,
0.001 mL per sec to 10 mL per sec) to ensure that a good coating of
the fibrosis-inhibiting (or gliosis-inhibiting) agent is obtained.
The coated device, lead or electrode can be air-dried. The spray
coating process can be repeated one or more times depending on the
specific application. The device, lead or electrode can be dried
under vacuum to reduce residual solvent levels. This process can
result in the fibrosis-inhibiting (or gliosis-inhibiting)
agent/polymer being coated on the surface of the device, lead or
electrode.
[0879] Fibrosis-Inhibiting (or Gliosis-Inhibiting) Agent/Polymer
with a Swelling Solvent
[0880] In one embodiment, the solvent is one that will not dissolve
the device, lead or electrode but will be absorbed by it. These
solvents can thus swell the device, lead or electrode to some
extent. The device, lead or electrode can be spray coated, either
partially or completely, in the fibrosis-inhibiting (or
gliosis-inhibiting) agent/polymer/solvent solution. The rate of
spraying of the fibrosis-inhibiting (or gliosis-inhibiting)
agent/solvent solution can be altered (e.g., 0.001 mL per sec to 10
mL per sec) to ensure that a good coating of the
fibrosis-inhibiting (or gliosis-inhibiting) agent is obtained. The
coated device, lead or electrode can be air-dried. The spray
coating process can be repeated one or more times depending on the
specific application. The device, lead or electrode can be dried
under vacuum to reduce residual solvent levels. This process will
result in the fibrosis-inhibiting (or gliosis-inhibiting)
agent/polymer being coated onto the surface of the device, lead or
electrode as well as the potential for the fibrosis-inhibiting (or
gliosis-inhibiting) agent being adsorbed into the medical device,
lead or electrode. The fibrosis-inhibiting (or gliosis-inhibiting)
agent may also be present on the surface of the device, lead or
electrode. The amount of surface associated fibrosis-inhibiting (or
gliosis-inhibiting) agent may be reduced by dipping the coated
device, lead or electrode into a solvent for the
fibrosis-inhibiting (or gliosis-inhibiting) agent or by spraying
the coated device, lead or electrode with a solvent for the
fibrosis-inhibiting (or gliosis-inhibiting) agent.
[0881] Fibrosis-Inhibiting (or Gliosis-Inhibiting) Agent/Polymer
with a Solvent
[0882] In one embodiment, the solvent is one that will be absorbed
by the device, lead or electrode and that will dissolve it. The
device, lead or electrode can be spray coated, either partially or
completely, in the fibrosis-inhibiting (or gliosis-inhibiting)
agent/solvent solution. The rate of spraying of the
fibrosis-inhibiting (or gliosis-inhibiting) agent/solvent solution
can be altered (e.g., 0.001 mL per sec to 10 mL per sec) to ensure
that a good coating of the fibrosis-inhibiting (or
gliosis-inhibiting) agent is obtained. The coated device, lead or
electrode can be air-dried. The spray coating process can be
repeated one or more times depending on the specific application.
The device, lead or electrode can be dried under vacuum to reduce
residual solvent levels. In the preferred embodiment, the exposure
time of the device, lead or electrode to the solvent may not incur
significant permanent dimensional changes to it (other than those
associated with the coating itself). The fibrosis-inhibiting (or
gliosis-inhibiting) agent may also be present on the surface of the
device, lead or electrode. The amount of surface associated
fibrosis-inhibiting (or gliosis-inhibiting) agent may be reduced by
dipping the coated device, lead or electrode into a solvent for the
fibrosis-inhibiting (or gliosis-inhibiting) agent or by spraying
the coated device, lead or electrode with a solvent for the
fibrosis-inhibiting (or gliosis-inhibiting) agent.
[0883] In the above description the device, lead or electrode can
be one that has not been modified as well as one that has been
further modified by coating with a polymer (e.g., parylene),
surface treated by plasma treatment, flame treatment, corona
treatment, surface oxidation or reduction, surface etching,
mechanical smoothing or roughening, or grafting prior to the
coating process.
[0884] In another embodiment, a suspension of the
fibrosis-inhibiting (or gliosis-inhibiting) agent in a polymer
solution can be prepared. The suspension can be prepared by
choosing a solvent that can dissolve the polymer but not the
fibrosis-inhibiting (or gliosis-inhibiting) agent, or a solvent
that can dissolve the polymer and in which the fibrosis-inhibiting
(or gliosis-inhibiting) agent is above its solubility limit. In
similar processes described above, the suspension of the
fibrosis-inhibiting (or gliosis-inhibiting) and polymer solution
can be sprayed onto the CRM or neurostimulation device, lead or
electrode such that it is coated with a polymer that has a
fibrosis-inhibiting (or gliosis-inhibiting) agent suspended within
it.
[0885] The present invention, in various aspects and embodiments,
provides the following medical devices:
[0886] 1. Electrical Device
[0887] In one aspect, the present invention provides a medical
device, comprising an electrical device and an anti-scarring agent
or a composition comprising an anti-scarring agent, wherein the
agent inhibits scarring between the medical device and the host
into which the medical device is implanted.
[0888] Such a medical device may be defined by one, two, or more of
the following features: the electrical device is a neurostimulator;
the electrical device is a spinal cord stimulator; the electrical
device is a brain stimulator; the electrical device is a vagus
nerve stimulator; the electrical device is a sacral nerve
stimulator; the electrical device is a gastric nerve stimulator;
the electrical device is an auditory nerve stimulator; the
electrical device delivers stimulation to organs; the electrical
device delivers stimulation to bone; the electrical device delivers
stimulation to muscles; the electrical device delivers stimulation
to tissues; the electrical device is a device for continuous
subarachnoid infusion; the electrical device is an implantable
electrode; the electrical device is an implantable pulse generator;
the electrical device is an electrical lead; the electrical device
is a stimulation lead; the electrical device is a simulation
catheter lead; the electrical device is cochlear implant; the
electrical device is a microstimulator; the electrical device is
battery powered; the electrical device is radio frequency powered;
the electrical device is both battery and radio frequency powered;
the electrical device is a cardiac rhythm management device; the
electrical device is a cardiac pacemaker; the electrical device is
an implantable cardioverter defibrillator system; the electrical
device is a cardiac lead; the electrical device is a pacer lead;
the electrical device is an endocardial lead; the electrical device
is a cardioversion/defibrillator lead; the electrical device is an
epicardial lead; the electrical device is an epicardial
defibrillator lead; the electrical device is a patch defibrillator;
the electrical device is a patch defibrillator lead; the electrical
device is an electrical patch; the electrical device is a
transvenous lead; the electrical device is an active fixation lead;
the electrical device is a passive fixation lead; the electrical
device is a sensing lead; the electrical device is a defibrillator;
the electrical device is an implantable sensor; the electrical
device is a left ventricular assist device; the electrical device
is a pulse generator; the electrical device is a patch lead; the
electrical device is an electrical patch; the electrical device is
a cardiac stimulator; the electrical device is an electrical
deviceable sensor; the electrical device is an electrical
deviceable pump; the electrical device is a dural patch; the
electrical device is a ventricular peritoneal shunt; the electrical
device is a ventricular atrial shunt; the electrical device is
adapted for treating or preventing epidural fibrosis
post-laminectomy; the electrical device is adapted for treating or
preventing cardiac rhythm abnormalities; the electrical device is
adapted for treating or preventing atrial rhythm abnormalities; the
electrical device is adapted for treating or preventing conduction
abnormalities; the electrical device is adapted for treating or
preventing ventricular rhythm abnormalities; the electrical device
is adapted for treating or preventing pain; the electrical device
is adapted for treating or preventing epilepsy; the electrical
device is adapted for treating or preventing Parkinson's disease;
the electrical device is adapted for treating or preventing
movement disorders; the electrical device is adapted for treating
or preventing obesity; the electrical device is adapted for
treating or preventing depression; the electrical device is adapted
for treating or preventing anxiety; the electrical device is
adapted for treating or preventing hearing loss; the electrical
device is adapted for treating or preventing ulcers; the electrical
device is adapted for treating or preventing deep vein thrombosis;
the electrical device is adapted for treating or preventing
muscular atrophy; the electrical device is adapted for treating or
preventing joint stiffness; the electrical device is adapted for
treating or preventing muscle spasms; the electrical device is
adapted for treating or preventing osteoporosis; the electrical
device is adapted for treating or preventing scoliosis; the
electrical device is adapted for treating or preventing spinal disc
degeneration; the electrical device is adapted for treating or
preventing spinal cord injury; the electrical device is adapted for
treating or preventing urinary dysfunction; the electrical device
is adapted for treating or preventing gastroparesis; the electrical
device is adapted for treating or preventing malignancy; the
electrical device is adapted for treating or preventing
arachnoiditis; the electrical device is adapted for treating or
preventing chronic disease; the electrical device is adapted for
treating or preventing migraine; the electrical device is adapted
for treating or preventing sleep disorders; the electrical device
is adapted for treating or preventing dementia; and the electrical
device is adapted for treating or preventing Alzheimer's
disease.
[0889] 2. Neurostimulator for Treating Chronic Pain
[0890] In one aspect, the present invention provides a medical
device, comprising a neurostimulator for treating chronic pain
(i.e., an electrical device) and an anti-scarring agent or a
composition comprising an anti-scarring agent, wherein the agent
inhibits scarring between the medical device and the host into
which the medical device is implanted.
[0891] Such a medical device may be further defined by one, two, or
more of the following features: the chronic pain results from
injury; the chronic pain results from an illness; the chronic pain
results from scoliosis; the chronic pain results from spinal disc
degeneration; the chronic pain results from malignancy; the chronic
pain results from arachnoiditis; the chronic pain results from a
chronic disease; the chronic pain results from a pain syndrome; the
neurostimulator comprises a lead that delivers electrical
stimulation to a nerve and an electrical connection that connects a
power source to the lead; the neurostimulator is adapted for spinal
cord stimulation, and comprises a sensor that detects the position
of the spine and a stimulator that emits pulses that decrease in
amplitude when the back is in a supine position; the
neurostimulator comprises an electrode and a control circuit that
generates pulses and rest period based on intervals corresponding
to the host body's activity and regeneration period; the
neurostimulator comprises a stimulation catheter lead and an
electrode; and the neurostimulator is a self-centering epidural
spinal cord lead.
[0892] 3. Neurostimulator for Treating Parkinson's Disease
[0893] In one aspect, the present invention provides a medical
device, comprising a neurostimulator for treating Parkinson's
Disease (i.e., an electrical device) and an anti-scarring agent or
a composition comprising an anti-scarring agent, wherein the agent
inhibits scarring between the medical device and the host into
which the medical device is implanted.
[0894] In certain embodiments, the neurostimulator comprises an
intracranially implantable electrical control module and an
electrode. In other embodiments, the neurostimulator comprises a
sensor and an electrode.
[0895] 4. Vagal Nerve Stimulator for Treating Epilepsy
[0896] In one aspect, the present invention provides a medical
device, comprising a vagal nerve stimulator for treating epilepsy
(i.e., an electrical device) and an anti-scarring agent or a
composition comprising an anti-scarring agent, wherein the agent
inhibits scarring between the medical device and the host into
which the medical device is implanted.
[0897] 5. Vagal Nerve Stimulator for Treating Other Disorders
[0898] In one aspect, the present invention provides a medical
device, comprising a vagal nerve stimulator (i.e., an electrical
device) and an anti-scarring agent or a composition comprising an
anti-scarring agent, wherein the agent inhibits scarring between
the medical device and the host into which the medical device is
implanted. Such a medical device may be further defined by one, two
or more of the following features: the vagal nerve stimulator is
adapted for treating or preventing depression; the vagal nerve
stimulator is adapted for treating or preventing anxiety; the vagal
nerve stimulator is adapted for treating or preventing panic
disorders; the vagal nerve stimulator is adapted for treating or
preventing obsessive-compulsive disorders; the vagal nerve
stimulator is adapted for treating or preventing post-traumatic
disorders; the vagal nerve stimulator is adapted for treating or
preventing obesity; the vagal nerve stimulator is adapted for
treating or preventing migraine; the vagal nerve stimulator is
adapted for treating or preventing sleep disorders; the vagal nerve
stimulator is adapted for treating or preventing dementia; the
vagal nerve stimulator is adapted for treating or preventing
Alzheimer's disease; and the vagal nerve stimulator is adapted for
treating or preventing chronic or degenerative neurological
disorders.
[0899] 6. Sacral Nerve Stimulator
[0900] In one aspect, the present invention provides a medical
device, comprising a sacral nerve stimulator for treating a bladder
control problem (i.e., an electrical device) and an anti-scarring
agent or a composition comprising an anti-scarring agent, wherein
the agent inhibits scarring between the medical device and the host
into which the medical device is implanted.
[0901] Such a medical device may be further defined by one, two, or
more of the following features: the sacral nerve stimulator is
adapted for treating or preventing urge incontinence; the sacral
nerve stimulator is adapted for treating or preventing
nonobstructive urinary retention; the sacral nerve stimulator is
adapted for treating or preventing urgency frequency; the sacral
nerve stimulator is an intramuscular electrical stimulator; and the
sacral nerve stimulator is a leadless, tubular-shaped
microstimulator.
[0902] 7. Gastric Nerve Stimulator
[0903] In one aspect, the present invention provides a medical
device, comprising a gastric nerve stimulator for treating a
gastrointestinal disorder (i.e., an electrical device) and an
anti-scarring agent or a composition comprising an anti-scarring
agent, wherein the agent inhibits scarring between the medical
device and the host into which the medical device is implanted.
[0904] Such a medical device may be further defined by one, two, or
more of the following features: the gastric nerve stimulator is
adapted for treating or preventing morbid obesity; the gastric
nerve stimulator is adapted for treating or preventing
constipation; the gastric nerve stimulator comprises an electrical
lead, an electrode and a stimulation generator; and the gastric
nerve stimulator comprises an electrical signal controller,
connector wire and an attachment lead.
[0905] 8. Cochlear lmplant
[0906] The present invention provides a medical device, comprising
a cochlear implant for treating deafness (i.e., an electrical
device) and an anti-scarring agent or a composition comprising an
anti-scarring agent, wherein the agent inhibits scarring between
the medical device and the host into which the medical device is
implanted.
[0907] Such a medical device may be further defined by one, two or
more the following features: the cochlear implant comprises a
plurality of transducer elements; the cochlear implant comprises a
sound-to-electrical stimulation encoder, a body implantable
receiver-stimulator, and electrodes; the cochlear implant comprises
a transducer and an electrode array; and the cochlear implant is a
subcranially implantable electomechanical system.
[0908] 9. Bone Growth Stimulator
[0909] In one aspect, the present invention provides a medical
device, comprising a bone growth stimulator (i.e., an electrical
device) and an anti-scarring agent or a composition comprising an
anti-scarring agent, wherein the agent inhibits scarring between
the medical device and the host into which the medical device is
implanted.
[0910] In certain embodiments, the bone growth stimulator comprises
an electrode and a generator having a strain response piezoelectric
material that responds to strain.
[0911] 10. Cardiac Pacemaker
[0912] In one aspect, the present invention provides a medical
device, comprising a cardiac pacemaker (i.e., an electrical device)
and an anti-scarring agent or a composition comprising an
anti-scarring agent, wherein the agent inhibits scarring between
the medical device and the host into which the medical device is
implanted.
[0913] In certain embodiments, the cardiac pacemaker is an adaptive
rate pacemaker. In certain other embodiments, the cardiac pacemaker
is a rate responsive pacemaker.
[0914] 11. Implantable Cardioverter Defibrillator
[0915] In one aspect, the present invention provides a medical
device, comprising an implantable cardioverter defibrillator (ICD)
system (i.e., an electrical device) and an anti-scarring agent or a
composition comprising an anti-scarring agent, wherein the agent
inhibits scarring between the medical device and the host into
which the medical device is implanted.
[0916] Such a medical device may be further defined by one, two, or
more of the following features: the implantable cardioverter
defibrillator is adapted for treating tachyarraythmias; the
implantable cardioverter defibrillator is adapted for ventricular
tachycardia; the implantable cardioverter defibrillator is adapted
for treating ventricular fibrillation; the implantable cardioverter
defibrillator is adapted for treating atrial tachycardia; the
implantable cardioverter defibrillator is adapted for treating
atrial fibrillation; the implantable cardioverter defibrillator is
adapted for treating arrhythmias.
[0917] 12. Implantable Cardioverter Defibrillator
[0918] In one aspect, the present invention provides a medical
device, comprising an implantable cardioverter defibrillator (ICD)
system (i.e., an electrical device) and an anti-scarring agent or a
composition comprising an anti-scarring agent, wherein the agent
inhibits scarring between the medical device and the host into
which the medical device is implanted.
[0919] Such a medical device may be further defined by one, two, or
more of the following features: the implantable cardioverter
defibrillator is adapted for treating tachyarraythmias; the
implantable cardioverter defibrillator is adapted for ventricular
tachycardia; the implantable cardioverter defibrillator is adapted
for treating ventricular fibrillation; the implantable cardioverter
defibrillator is adapted for treating atrial tachycardia; the
implantable cardioverter defibrillator is adapted for treating
atrial fibrillation; and the implantable cardioverter defibrillator
is adapted for treating arrhythmias.
[0920] 13. Vagus Nerve Stimulator for Treating Arrhythemia
[0921] In one aspect, the present invention provides a medical
device, comprising a vagus nerve stimulator for treating
arrhythemia (i.e., an electrical device) and an anti-scarring agent
or a composition comprising an anti-scarring agent, wherein the
agent inhibits scarring between the medical device and the host
into which the medical device is implanted.
[0922] Such a medical device may be further defined by one, two or
more of the following features: the vagus nerve stimulator is
adapted for treating supraventricular arrhythmias; the vagus nerve
stimulator is adapted for treating angina pectoris; the vagus nerve
stimulator is adapted for treating atrial tachycardia; the vagus
nerve stimulator is adapted for treating atrial flutter; the vagus
nerve stimulator is adapted for treating arterial fibrillation; the
vagus nerve stimulator is arrhythmias that result in low cardiac
output; and the vagus nerve stimulator comprises a programmable
pulse generator.
[0923] 14. Electrical Lead
[0924] In one aspect, the present invention provides a medical
device, comprising an electrical lead (i.e., an electrical device)
and an anti-scarring agent or a composition comprising an
anti-scarring agent, wherein the agent inhibits scarring between
the medical device and the host into which the medical device is
implanted.
[0925] Such a medical device may be further defined by one, two or
more of the following features: the electrical lead comprises a
connector assembly, a conductor and an electrode; the electrical
lead is unipolar; the electrical lead is bipolar; the electrical
lead is tripolar; the electrical lead is quadripolar; the
electrical lead comprises an insulating sheath; the electrical lead
is a medical lead; the electrical lead is a cardiac lead; the
electrical lead is a pacer lead; the electrical lead is a pacing
lead; the electrical lead is a pacemaker lead; the electrical lead
is an endocardial lead; the electrical lead is an endocardial
pacing lead; the electrical lead is a cardioversion lead; the
electrical lead is an epicardial lead; the electrical lead is an
epicardial defibrillator lead; the electrical lead is a patch
defibrillator; the electrical lead is a patch lead; the electrical
lead is an electrical patch; the electrical lead is a transvenous
lead; the electrical lead is an active fixation lead; the
electrical lead is a passive fixation lead; the electrical lead is
a sensing lead; the electrical lead is expandable; the electrical
lead has a coil configuration; and the electrical lead has an
active fixation element for attachment to host tissue.
[0926] 15. Neurostimulator
[0927] In one aspect, the present invention provides a medical
device, comprising a neurostimulator (i.e., an electrical device)
and an anti-scarring agent or a composition comprising an
anti-scarring agent, wherein the agent inhibits scarring between
the medical device and the host into which the medical device is
implanted.
[0928] Such a medical device may be further defined by one, two or
more of the following features: the electrical device is a
neurostimulator; the electrical device is a spinal cord stimulator;
the electrical device is a brain stimulator; the electrical device
is a vagus nerve stimulator; the electrical device is a sacral
nerve stimulator; the electrical device is a gastric nerve
stimulator; the electrical device is an auditory nerve stimulator;
the electrical device delivers stimulation to organs; the
electrical device delivers stimulation to bone; the electrical
device delivers stimulation to muscles; the electrical device
delivers stimulation to tissues; the electrical device is a device
for continuous subarachnoid infusion; the electrical device is an
implantable electrode; the electrical device is an electrical lead;
the electrical device is a simulation catheter lead; the electrical
device is cochlear implant; the electrical device is a
microstimulator; the electrical device is battery powered; the
electrical device is radio frequency powered; the electrical device
is both battery and radio frequency powered; the electrical device
is adapted for treating or preventing pain; the electrical device
is adapted for treating or preventing epilepsy; the electrical
device is adapted for treating or preventing Parkinson's disease;
the electrical device is adapted for treating or preventing
movement disorders; the electrical device is adapted for treating
or preventing obesity; the electrical device is adapted for
treating or preventing depression; the electrical device is adapted
for treating or preventing anxiety; the electrical device is
adapted for treating or preventing hearing loss; the electrical
device is adapted for treating or preventing ulcers; the electrical
device is adapted for treating or preventing deep vein thrombosis;
the electrical device is adapted for treating or preventing
muscular atrophy; the electrical device is adapted for treating or
preventing joint stiffness; the electrical device is adapted for
treating or preventing muscle spasms; the electrical device is
adapted for treating or preventing osteoporosis; the electrical
device is adapted for treating or preventing scoliosis; the
electrical device is adapted for treating or preventing spinal disc
degeneration; the electrical device is adapted for treating or
preventing spinal cord injury; the electrical device is adapted for
treating or preventing urinary dysfunction; the electrical device
is adapted for treating or preventing gastroparesis; the electrical
device is adapted for treating or preventing malignancy; the
electrical device is adapted for treating or preventing
arachnoiditis; the electrical device is adapted for treating or
preventing chronic disease; the electrical device is adapted for
treating or preventing migraine; the electrical device is adapted
for treating or preventing sleep disorders; the electrical device
is adapted for treating or preventing dementia; and the electrical
device is adapted for treating or preventing Alzheimer's
disease.
[0929] 16. Cardiac Rhythm Management Device
[0930] In one aspect, the present invention provides a medical
device, comprising a cardiac rhythm management device (i.e., an
electrical device) and an anti-scarring agent or a composition
comprising an anti-scarring agent, wherein the agent inhibits
scarring between the medical device and the host into which the
medical device is implanted.
[0931] Such a medical device may be defined by one, two or more of
the following features: the electrical device is an implantable
pulse generator; the electrical device is an electrical lead; the
electrical device is a stimulation lead; the electrical device is a
simulation catheter lead; the electrical device is a
microstimulator; the electrical device is battery powered; the
electrical device is radio frequency powered; the electrical device
is both battery and radio frequency powered; the electrical device
is a cardiac pacemaker; the electrical device is an implantable
cardioverter defibrillator system; the electrical device is a
cardiac lead; the electrical device is a pacer lead; the electrical
device is an endocardial lead; the electrical device is a
cardioversion/defibrillator lead; the electrical device is an
epicardial lead; the electrical device is an epicardial
defibrillator lead; the electrical device is a patch defibrillator;
the electrical device is a patch defibrillator lead; the electrical
device is an electrical patch; the electrical device is a
transvenous lead; the electrical device is an active fixation lead;
the electrical device is a passive fixation lead; the electrical
device is a sensing lead; the electrical device is a defibrillator;
the electrical device is an implantable sensor; the electrical
device is a left ventricular assist device; the electrical device
is a pulse generator; the electrical device is a patch lead; the
electrical device is an electrical patch; the electrical device is
a cardiac stimulator; the electrical device is an electrical
deviceable sensor; the electrical device is an electrical
deviceable pump; the electrical device is a dural patch; the
electrical device is a ventricular peritoneal shunt; the electrical
device is a ventricular atrial shunt; the electrical device is
adapted for treating or preventing epidural fibrosis
post-laminectomy; the electrical device is adapted for treating or
preventing cardiac rhythm abnormalities; the electrical device is
adapted for treating or preventing atrial rhythm abnormalities; the
electrical device is adapted for treating or preventing conduction
abnormalities; and the electrical device is adapted for treating or
preventing ventricular rhythm abnormalities.
[0932] Additional Features Related to Medical Devices
[0933] The medical devices described above may also be defined by
one, two or more of the following features: the agent inhibits cell
regeneration; the agent inhibits angiogenesis; the agent inhibits
fibroblast migration; the agent inhibits fibroblast proliferation;
the agent inhibits deposition of extracellular matrix; the agent
inhibits tissue remodeling; the agent is an angiogenesis inhibitor;
the agent is a 5-lipoxygenase inhibitor or antagonist; the agent is
a chemokine receptor antagonist; the agent is a cell cycle
inhibitor; the agent is a taxane; the agent is an anti-microtubule
agent; the agent is paclitaxel; the agent is not paclitaxel; the
agent is an analogue or derivative of paclitaxel; the agent is a
vinca alkaloid; the agent is camptothecin or an analogue or
derivative thereof; the agent is a podophyllotoxin; the agent is a
podophyllotoxin, wherein the podophyllotoxin is etoposide or an
analogue or derivative thereof; the agent is an anthracycline; the
agent is an anthracycline, wherein the anthracycline is doxorubicin
or an analogue or derivative thereof; the agent is an
anthracycline, wherein the anthracycline is mitoxantrone or an
analogue or derivative thereof; the agent is a platinum compound;
the agent is a nitrosourea; the agent is a nitroimidazole; the
agent is a folic acid antagonist; the agent is a cytidine analogue;
the agent is a pyrimidine analogue; the agent is a fluoropyrimidine
analogue; the agent is a purine analogue; the agent is a nitrogen
mustard or an analogue or derivative thereof; the agent is a
hydroxyurea; the agent is a mytomicin or an analogue or derivative
thereof; the agent is an alkyl sulfonate; the agent is a benzamide
or an analogue or derivative thereof; the agent is a nicotinamide
or an analogue or derivative thereof; the agent is a halogenated
sugar or an analogue or derivative thereof; the agent is a DNA
alkylating agent; the agent is an anti-microtubule agent; the agent
is a topoisomerase inhibitor; the agent is a DNA cleaving agent;
the agent is an antimetabolite; the agent inhibits adenosine
deaminase; the agent inhibits purine ring synthesis; the agent is a
nucleotide interconversion inhibitor; the agent inhibits
dihydrofolate reduction; the agent blocks thymidine monophosphate;
the agent causes DNA damage; the agent is a DNA intercalation
agent; the agent is a RNA synthesis inhibitor; the agent is a
pyrimidine synthesis inhibitor; the agent inhibits ribonucleotide
synthesis or function; the agent inhibits thymidine monophosphate
synthesis or function; the agent inhibits DNA synthesis; the agent
causes DNA adduct formation; the agent inhibits protein synthesis;
the agent inhibits microtubule function; the agent is a cyclin
dependent protein kinase inhibitor; the agent is an epidermal
growth factor kinase inhibitor; the agent is an elastase inhibitor;
the agent is a factor Xa inhibitor; the agent is a
farnesyltransferase inhibitor; the agent is a fibrinogen
antagonist; the agent is a guanylate cyclase stimulant; the agent
is a heat shock protein 90 antagonist; the agent is a heat shock
protein 90 antagonist, wherein the heat shock protein 90 antagonist
is geldanamycin or an analogue or derivative thereof; the agent is
a guanylate cyclase stimulant; the agent is a HMGCoA reductase
inhibitor; the agent is a HMGCoA reductase inhibitor, wherein the
HMGCoA reductase inhibitor is simvastatin or an analogue or
derivative thereof; the agent is a hydroorotate dehydrogenase
inhibitor; the agent is an IKK2 inhibitor; the agent is an IL-1
antagonist; the agent is an ICE antagonist; the agent is an IRAK
antagonist; the agent is an IL-4 agonist; the agent is an
immunomodulatory agent; the agent is sirolimus or an analogue or
derivative thereof; the agent is not sirolimus; the agent is
everolimus or an analogue or derivative thereof; the agent is
tacrolimus or an analogue or derivative thereof; the agent is not
tacrolimus; the agent is biolmus or an analogue or derivative
thereof; the agent is tresperimus or an analogue or derivative
thereof; the agent is auranofin or an analogue or derivative
thereof; the agent is 27-0-demethylrapamycin or an analogue or
derivative thereof; the agent is gusperimus or an analogue or
derivative thereof; the agent is pimecrolimus or an analogue or
derivative thereof; the agent is ABT-578 or an analogue or
derivative thereof; the agent is an inosine monophosphate
dehydrogenase (IMPDH) inhibitor; the agent is an IMPDH inhibitor,
wherein the IMPDH inhibitor is mycophenolic acid or an analogue or
derivative thereof; the agent is an IMPDH inhibitor, wherein the
IMPDH inhibitor is 1-alpha-25 dihydroxy vitamin D.sub.3 or an
analogue or derivative thereof; the agent is a leukotriene
inhibitor; the agent is a MCP-1 antagonist; the agent is a MMP
inhibitor; the agent is an NF kappa B inhibitor; the agent is an NF
kappa B inhibitor, wherein the NF kappa B inhibitor is Bay 11-7082;
the agent is an NO antagonist; the agent is a p38 MAP kinase
inhibitor; the agent is a p38 MAP kinase inhibitor, wherein the p38
MAP kinase inhibitor is SB 202190; the agent is a phosphodiesterase
inhibitor; the agent is a TGF beta inhibitor; the agent is a
thromboxane A2 antagonist; the agent is a TNF.alpha. antagonist;
the agent is a TACE inhibitor; the agent is a tyrosine kinase
inhibitor; the agent is a vitronectin inhibitor; the agent is a
fibroblast growth factor inhibitor; the agent is a protein kinase
inhibitor; the agent is a PDGF receptor kinase inhibitor; the agent
is an endothelial growth factor receptor kinase inhibitor; the
agent is a retinoic acid receptor antagonist; the agent is a
platelet derived growth factor receptor kinase inhibitor; the agent
is a fibrinogen antagonist; the agent is an antimycotic agent; the
agent is an antimycotic agent, wherein the antimycotic agent is
sulconizole; the agent is a bisphosphonate; the agent is a
phospholipase A1 inhibitor; the agent is a histamine H1/H2/H3
receptor antagonist; the agent is a macrolide antibiotic; the agent
is a GPIIb/IIIa receptor antagonist; the agent is an endothelin
receptor antagonist; the agent is a peroxisome
proliferator-activated receptor agonist; the agent is an estrogen
receptor agent; the agent is a somastostatin analogue; the agent is
a neurokinin 1 antagonist; the agent is a neurokinin 3 antagonist;
the agent is a VLA-4 antagonist; the agent is an osteoclast
inhibitor; the agent is a DNA topoisomerase ATP hydrolyzing
inhibitor; the agent is an angiotensin I converting enzyme
inhibitor; the agent is an angiotensin II antagonist; the agent is
an enkephalinase inhibitor; the agent is a peroxisome
proliferator-activated receptor gamma agonist insulin sensitizer;
the agent is a protein kinase C inhibitor; the agent is a ROCK
(rho-associated kinase) inhibitor; the agent is a CXCR3 inhibitor;
the agent is an Itk inhibitor; the agent is a cytosolic
phospholipase A.sub.2-alpha inhibitor; the agent is a PPAR agonist;
the agent is an immunosuppressant; the agent is an Erb inhibitor;
the agent is an apoptosis agonist; the agent is a lipocortin
agonist; the agent is a VCAM-1 antagonist; the agent is a collagen
antagonist; the agent is an alpha 2 integrin antagonist; the agent
is a TNF alpha inhibitor; the agent is a nitric oxide inhibitor;
the agent is a cathepsin inhibitor; the agent is not an
anti-inflammatory agent; the agent is not a steroid; the agent is
not a glucocorticosteroid; the agent is not dexamethasone,
beclomethasone, or dipropionate; the agent is not an anti-infective
agent; the agent is not an antibiotic; the agent is not an
anti-fugal agent; the agent is not beclomethasone; the agent is not
dipropionate; the medical device further comprises a coating,
wherein the coating comprises the anti-scarring agent and a
polymer; the medical device further comprises a coating, wherein
the coating comprises the anti-scarring agent; the medical device
further comprises a coating, wherein the coating is disposed on a
surface of the electrical device; the medical device further
comprises a coating, wherein the coating directly contacts the
electrical device; the medical device further comprises a coating,
wherein the coating indirectly contacts the electrical device; the
medical device further comprises a coating, wherein the coating
partially covers the electrical device; the medical device further
comprises a coating, wherein the coating completely covers the
electrical device; the medical device further comprises a coating,
wherein the coating is a uniform coating; the medical device
further comprises a coating, wherein the coating is a non-uniform
coating; the medical device further comprises a coating, wherein
the coating is a discontinuous coating; the medical device further
comprises a coating, wherein the coating is a patterned coating;
the medical device further comprises a coating, wherein the coating
has a thickness of 100 .mu.m or less; the medical device further
comprises a coating, wherein the coating has a thickness of 10
.mu.m or less; the medical device further comprises a coating,
wherein the coating adheres to the surface of the electrical device
upon deployment of the medical device; the medical device further
comprises a coating, wherein the coating is stable at room
temperature for a period of 1 year; the medical device further
comprises a coating, wherein the anti-scarring agent is present in
the coating in an amount ranging between about 0.0001% to about 1%
by weight; the medical device further comprises a coating, wherein
the anti-scarring agent is present in the coating in an amount
ranging between about 1% to about 10% by weight; the medical device
further comprises a coating, wherein the anti-scarring agent is
present in the coating in an amount ranging between about 10% to
about 25% by weight; the medical device further comprises a
coating, wherein the anti-scarring agent is present in the coating
in an amount ranging between about 25% to about 70% by weight; the
medical device further comprises a coating, wherein the coating
further comprises a polymer; the medical device further comprises a
first coating having a first composition and the second coating
having a second composition; the medical device further comprises a
first coating having a first composition and the second coating
having a second composition, wherein the first composition and the
second composition are different; the medical device further
comprises a polymer; the medical device further comprises a
polymeric carrier; the medical device further comprises a polymeric
carrier, wherein the polymeric carrier comprises a copolymer; the
medical device further comprises a polymeric carrier, wherein the
polymeric carrier comprises a block copolymer; the medical device
further comprises a polymeric carrier, wherein the polymeric
carrier comprises a random copolymer; the medical device further
comprises a polymeric carrier, wherein the polymeric carrier
comprises a biodegradable polymer; the medical device further
comprises a polymeric carrier, wherein the polymeric carrier
comprises a non-biodegradable polymer; the medical device further
comprises a polymeric carrier, wherein the polymeric carrier
comprises a hydrophilic polymer; the medical device further
comprises a polymeric carrier, wherein the polymeric carrier
comprises a hydrophobic polymer; the medical device further
comprises a polymeric carrier, wherein the polymeric carrier
comprises a polymer having hydrophilic domains; the medical device
further comprises a polymeric carrier, wherein the polymeric
carrier comprises a polymer having hydrophobic domains; the medical
device further comprises a polymeric carrier, wherein the polymeric
carrier comprises a non-conductive polymer; the medical device
further comprises a polymeric carrier, wherein the polymeric
carrier comprises an elastomer; the medical device further
comprises a polymeric carrier, wherein the polymeric carrier
comprises a hydrogel; the medical device further comprises a
polymeric carrier, wherein the polymeric carrier comprises a
silicone polymer; the medical device further comprises a polymeric
carrier, wherein the polymeric carrier comprises a hydrocarbon
polymer; the medical device further comprises a polymeric carrier,
wherein the polymeric carrier comprises a styrene-derived polymer;
the medical device further comprises a polymeric carrier, wherein
the polymeric carrier comprises a butadiene polymer; the medical
device further comprises a polymeric carrier, wherein the polymeric
carrier comprises a macromer; the medical device further comprises
a polymeric carrier, wherein the polymeric carrier comprises a
poly(ethylene glycol) polymer; the medical device further comprises
a polymeric carrier, wherein the polymeric carrier comprises an
amorphous polymer; the medical device further comprises a
lubricious coating; the anti-scarring agent is located within pores
or holes of the electrical device; the anti-scarring agent is
located within a channel, lumen, or divet of the electrical device;
the medical device further comprises a second pharmaceutically
active agent; the medical device further comprises an
anti-inflammatory agent; the medical device further comprises an
agent that inhibits infection; the medical device further comprises
an agent that inhibits infection, wherein the agent is an
anthracycline; the medical device further comprises an agent that
inhibits infection, wherein the agent is doxorubicin; the medical
device further comprises an agent that inhibits infection, wherein
the agent is mitoxantrone; the medical device further comprises an
agent that inhibits infection, wherein the agent is a
fluoropyrimidine; the medical device further comprises an agent
that inhibits infection, wherein the agent is 5-fluorouracil
(5-FU); the medical device further comprises an agent that inhibits
infection, wherein the agent is a folic acid antagonist; the
medical device further comprises an agent that inhibits infection,
wherein the agent is methotrexate; the medical device further
comprises an agent that inhibits infection, wherein the agent is a
podophylotoxin; the medical device further comprises an agent that
inhibits infection, wherein the agent is etoposide; the medical
device further comprises an agent that inhibits infection, wherein
the agent is a camptothecin; the medical device further comprises
an agent that inhibits infection, wherein the agent is a
hydroxyurea; the medical device further comprises an agent that
inhibits infection, wherein the agent is a platinum complex; the
medical device further comprises an agent that inhibits infection,
wherein the agent is cisplatin; the medical device further
comprises an anti-thrombotic agent; the medical device further
comprises a visualization agent; the medical device further
comprises a visualization agent, wherein the visualization agent is
a radiopaque material, wherein the radiopaque material comprises a
metal, a halogenated compound, or a barium containing compound; the
medical device further comprises a visualization agent, wherein the
visualization agent is a radiopaque material, wherein the
radiopaque material comprises barium, tantalum, or technetium; the
medical device further comprises a visualization agent, wherein the
visualization agent is a MRI responsive material; the medical
device further comprises a visualization agent, wherein the
visualization agent comprises a gadolinium chelate; the medical
device further comprises a visualization agent, wherein the
visualization agent comprises iron, magnesium, manganese, copper,
or chromium; the medical device further comprises a visualization
agent, wherein the visualization agent comprises an iron oxide
compound; the medical device further comprises a visualization
agent, wherein the visualization agent comprises a dye, pigment, or
colorant; the medical device further comprises an echogenic
material; the medical device further comprises an echogenic
material, wherein the echogenic material is in the form of a
coating; the device is sterile; the anti-scarring agent inhibits
adhesion between the medical device and a host into which the
medical device is implanted; the medical device delivers the
anti-scarring agent locally to tissue proximate to the medical
device; the anti-scarring agent is released into tissue in the
vicinity of the medical device after deployment of the medical
device; the anti-scarring agent is released into tissue in the
vicinity of the medical device after deployment of the medical
device, wherein the tissue is connective tissue; the anti-scarring
agent is released into tissue in the vicinity of the medical device
after deployment of the medical device, wherein the tissue is
muscle tissue; the anti-scarring agent is released into tissue in
the vicinity of the medical device after deployment of the medical
device, wherein the tissue is nerve tissue; the anti-scarring agent
is released into tissue in the vicinity of the medical device after
deployment of the medical device, wherein the tissue is epithelium
tissue; the anti-scarring agent is released in effective
concentrations from the medical device over a period ranging from
the time of deployment of the medical device to about 1 year; the
anti-scarring agent is released in effective concentrations from
the medical device over a period ranging from about 1 month to 6
months; the anti-scarring agent is released in effective
concentrations from the medical device over a period ranging
from about 1-90 days; the anti-scarring agent is released in
effective concentrations from the medical device at a constant
rate; the anti-scarring agent is released in effective
concentrations from the medical device at an increasing rate; the
anti-scarring agent is released in effective concentrations from
the medical device at a decreasing rate; the anti-scarring agent is
released in effective concentrations from the composition
comprising the anti-scarring agent by diffusion over a period
ranging from the time of deployment of the medical device to about
90 days; the anti-scarring agent is released in effective
concentrations from the composition comprising the anti-scarring
agent by erosion of the composition over a period ranging from the
time of deployment of the medical device to about 90 days; the
device comprises about 0.01 .mu.g to about 10 .mu.g of the
anti-scarring agent; the device comprises about 10 .mu.g to about
10 mg of the anti-scarring agent; the device comprises about 10 mg
to about 250 mg of the anti-scarring agent; the device comprises
about 250 mg to about 1000 mg of the anti-scarring agent; the
device comprises about 1000 mg to about 2500 mg of the
anti-scarring agent; a surface of the device comprises less than
0.01 .mu.g of the anti-scarring agent per mm.sup.2 of device
surface to which the anti-scarring agent is applied; a surface of
the device comprises about 0.01 .mu.g to about 1 .mu.g of the
anti-scarring agent per mm.sup.2 of device surface to which the
anti-scarring agent is applied; a surface of the device comprises
about 1 .mu.g to about 10 .mu.g of the anti-scarring agent per
mm.sup.2 of device surface to which the anti-scarring agent is
applied; a surface of the device comprises about 10 .mu.g to about
250 .mu.g of the anti-scarring agent per mm.sup.2 of device surface
to which the anti-scarring agent is applied; a surface of the
device comprises about 250 .mu.g to about 1000 .mu.g of the
anti-scarring agent of anti-scarring agent per mm.sup.2 of device
surface to which the anti-scarring agent is applied; a surface of
the device comprises about 1000 .mu.g to about 2500 .mu.g of the
anti-scarring agent per mm.sup.2 of device surface to which the
anti-scarring agent is applied; the agent or the composition is
affixed to the electrical device; the agent or the composition is
covalently attached to the electrical device; the agent or the
composition is non-covalently attached to the electrical device;
the medical device further comprises a coating that absorbs the
agent or the composition; the electrical device is interweaved with
a thread composed of, or coated with, the agent or the composition;
a portion of the electrical device is covered with a sleeve that
contains the agent or the composition; the electrical device is
completely covered with a sleeve that contains the agent or the
composition; a portion of the electrical device is covered with a
mesh that contains the agent or the composition; and the electrical
device is completely covered with a mesh that contains the agent or
the composition.
[0934] The present invention, in various aspects and embodiments,
provides the following methods for inhibiting scarring:
[0935] 1. Electrical Device
[0936] In one aspect, the present invention provides a method for
inhibiting scarring comprising placing an electrical device and an
anti-scarring agent or a composition comprising an ant-scarring
agent into an animal host, wherein the agent inhibits scarring.
[0937] Such a method may be defined by one, two, or more of the
following features: the electrical device is a neurostimulator; the
electrical device is a spinal cord stimulator; the electrical
device is a brain stimulator; the electrical device is a vagus
nerve stimulator; the electrical device is a sacral nerve
stimulator; the electrical device is a gastric nerve stimulator;
the electrical device is an auditory nerve stimulator; the
electrical device delivers stimulation to organs; the electrical
device delivers stimulation to bone; the electrical device delivers
stimulation to muscles; the electrical device delivers stimulation
to tissues; the electrical device is a device for continuous
subarachnoid infusion; the electrical device is an implantable
electrode; the electrical device is an implantable pulse generator;
the electrical device is an electrical lead; the electrical device
is a stimulation lead; the electrical device is a simulation
catheter lead; the electrical device is cochlear implant; the
electrical device is a microstimulator; the electrical device is
battery powered; the electrical device is radio frequency powered;
the electrical device is both battery and radio frequency powered;
the electrical device is a cardiac rhythm management device; the
electrical device is a cardiac pacemaker; the electrical device is
an implantable cardioverter defibrillator system; the electrical
device is a cardiac lead; the electrical device is a pacer lead;
the electrical device is an endocardial lead; the electrical device
is a cardioversion/defibrillator lead; the electrical device is an
epicardial lead; the electrical device is an epicardial
defibrillator lead; the electrical device is a patch defibrillator;
the electrical device is a patch defibrillator lead; the electrical
device is an electrical patch; the electrical device is a
transvenous lead; the electrical device is an active fixation lead;
the electrical device is a passive fixation lead; the electrical
device is a sensing lead; the electrical device is a defibrillator;
the electrical device is an implantable sensor; the electrical
device is a left ventricular assist device; the electrical device
is a pulse generator; the electrical device is a patch lead; the
electrical device is an electrical patch; the electrical device is
a cardiac stimulator; the electrical device is an electrical
deviceable sensor; the electrical device is an electrical
deviceable pump; the electrical device is a dural patch; the
electrical device is a ventricular peritoneal shunt; the electrical
device is a ventricular atrial shunt; the electrical device is
adapted for treating or preventing epidural fibrosis
post-laminectomy; the electrical device is adapted for treating or
preventing cardiac rhythm abnormalities; the electrical device is
adapted for treating or preventing atrial rhythm abnormalities; the
electrical device is adapted for treating or preventing conduction
abnormalities; the electrical device is adapted for treating or
preventing ventricular rhythm abnormalities; the electrical device
is adapted for treating or preventing pain; the electrical device
is adapted for treating or preventing epilepsy; the electrical
device is adapted for treating or preventing Parkinson's disease;
the electrical device is adapted for treating or preventing
movement disorders; the electrical device is adapted for treating
or preventing obesity; the electrical device is adapted for
treating or preventing depression; the electrical device is adapted
for treating or preventing anxiety; the electrical device is
adapted for treating or preventing hearing loss; the electrical
device is adapted for treating or preventing ulcers; the electrical
device is adapted for treating or preventing deep vein thrombosis;
the electrical device is adapted for treating or preventing
muscular atrophy; the electrical device is adapted for treating or
preventing joint stiffness; the electrical device is adapted for
treating or preventing muscle spasms; the electrical device is
adapted for treating or preventing osteoporosis; the electrical
device is adapted for treating or preventing scoliosis; the
electrical device is adapted for treating or preventing spinal disc
degeneration; the electrical device is adapted for treating or
preventing spinal cord injury; the electrical device is adapted for
treating or preventing urinary dysfunction; the electrical device
is adapted for treating or preventing gastroparesis; the electrical
device is adapted for treating or preventing malignancy; the
electrical device is adapted for treating or preventing
arachnoiditis; the electrical device is adapted for treating or
preventing chronic disease; the electrical device is adapted for
treating or preventing migraine; the electrical device is adapted
for treating or preventing sleep disorders; the electrical device
is adapted for treating or preventing dementia; and the electrical
device is adapted for treating or preventing Alzheimer's
disease.
[0938] 2. Neurostimulator for Treating Chronic Pain
[0939] In one aspect, the present invention provides a method for
inhibiting scarring comprising placing a neurostimulator for
treating chronic pain (i.e., an electrical device) and an
anti-scarring agent or a composition comprising an ant-scarring
agent into an animal host, wherein the agent inhibits scarring.
[0940] Such a method may be further defined by one, two, or more of
the following features: the chronic pain results from injury; the
chronic pain results from an illness; the chronic pain results from
scoliosis; the chronic pain results from spinal disc degeneration;
the chronic pain results from malignancy; the chronic pain results
from arachnoiditis; the chronic pain results from a chronic
disease; the chronic pain results from a pain syndrome; the
neurostimulator comprises a lead that delivers electrical
stimulation to a nerve and an electrical connection that connects a
power source to the lead; the neurostimulator is adapted for spinal
cord stimulation, and comprises a sensor that detects the position
of the spine and a stimulator that emits pulses that decrease in
amplitude when the back is in a supine position; the
neurostimulator comprises an electrode and a control circuit that
generates pulses and rest period based on intervals corresponding
to the host body's activity and regeneration period; the
neurostimulator comprises a stimulation catheter lead and an
electrode; and the neurostimulator is a self-centering epidural
spinal cord lead.
[0941] 3. Neurostimulator for Treating Parkinson's Disease
[0942] In one aspect, the present invention provides a method for
inhibiting scarring comprising placing a neurostimulator for
treating Parkinson's Disease (i.e., an electrical device) and an
anti-scarring agent or a composition comprising an ant-scarring
agent into an animal host, wherein the agent inhibits scarring.
[0943] In certain embodiments, the neurostimulator comprises an
intracranially implantable electrical control module and an
electrode. In other embodiments, the neurostimulator comprises a
sensor and an electrode.
[0944] 4. Vagal Nerve Stimulator for Treating Epilepsy
[0945] In one aspect, the present invention provides a method for
inhibiting scarring comprising placing a vagal nerve stimulator for
treating epilepsy (i.e., an electrical device) and an anti-scarring
agent or a composition comprising an ant-scarring agent into an
animal host, wherein the agent inhibits scarring.
[0946] 5. Vagal Nerve Stimulator for Treating Other Disorders
[0947] In one aspect, the present invention provides a method for
inhibiting scarring comprising placing a vagal nerve stimulator
(i.e., an electrical device) and an anti-scarring agent or a
composition comprising an ant-scarring agent into an animal host,
wherein the agent inhibits scarring.
[0948] Such a method may be further defined by one, two or more of
the following features: the vagal nerve stimulator is adapted for
treating or preventing depression; the vagal nerve stimulator is
adapted for treating or preventing anxiety; the vagal nerve
stimulator is adapted for treating or preventing panic disorders;
the vagal nerve stimulator is adapted for treating or preventing
obsessive-compulsive disorders; the vagal nerve stimulator is
adapted for treating or preventing post-traumatic disorders; the
vagal nerve stimulator is adapted for treating or preventing
obesity; the vagal nerve stimulator is adapted for treating or
preventing migraine; the vagal nerve stimulator is adapted for
treating or preventing sleep disorders; the vagal nerve stimulator
is adapted for treating or preventing dementia; the vagal nerve
stimulator is adapted for treating or preventing Alzheimer's
disease; and the vagal nerve stimulator is adapted for treating or
preventing chronic or degenerative neurological disorders.
[0949] 6. Sacral Nerve Stimulator
[0950] In one aspect, the present invention provides a method for
inhibiting scarring comprising placing a sacral nerve stimulator
for treating a bladder control problem (i.e., an electrical device)
and an anti-scarring agent or a composition comprising an
ant-scarring agent into an animal host, wherein the agent inhibits
scarring.
[0951] Such a method may be further defined by one, two, or more of
the following features: the sacral nerve stimulator is adapted for
treating or preventing urge incontinence; the sacral nerve
stimulator is adapted for treating or preventing nonobstructive
urinary retention; the sacral nerve stimulator is adapted for
treating or preventing urgency frequency; the sacral nerve
stimulator is an intramuscular electrical stimulator; and the
sacral nerve stimulator is a leadless, tubular-shaped
microstimulator.
[0952] 7. Gastric Nerve Stimulator
[0953] In one aspect, the present invention provides a method for
inhibiting scarring comprising placing a gastric nerve stimulator
for treating a gastrointestinal disorder (i.e., an electrical
device) and an anti-scarring agent or a composition comprising an
ant-scarring agent into an animal host, wherein the agent inhibits
scarring.
[0954] Such a method may be further defined by one, two, or more of
the following features: the gastric nerve stimulator is adapted for
treating or preventing morbid obesity; the gastric nerve stimulator
is adapted for treating or preventing constipation; the gastric
nerve stimulator comprises an electrical lead, an electrode and a
stimulation generator; and the gastric nerve stimulator comprises
an electrical signal controller, connector wire and an attachment
lead.
[0955] 8. Cochlear Implant
[0956] The present invention provides a method for inhibiting
scarring comprising placing a cochlear implant for treating
deafness (i.e., an electrical device) and an anti-scarring agent or
a composition comprising an ant-scarring agent into an animal host,
wherein the agent inhibits scarring.
[0957] Such a method may be further defined by one, two or more the
following features: the cochlear implant comprises a plurality of
transducer elements; the cochlear implant comprises a
sound-to-electrical stimulation encoder, a body implantable
receiver-stimulator, and electrodes; the cochlear implant comprises
a transducer and an electrode array; and the cochlear implant is a
subcranially implantable electomechanical system.
[0958] 9. Bone Growth Stimulator
[0959] In one aspect, the present invention provides a method for
inhibiting scarring comprising placing a bone growth stimulator
(i.e., an electrical device) and an anti-scarring agent or a
composition comprising an ant-scarring agent into an animal host,
wherein the agent inhibits scarring.
[0960] In certain embodiments, the bone growth stimulator comprises
an electrode and a generator having a strain response piezoelectric
material that responds to strain.
[0961] 10. Cardiac Pacemaker
[0962] In one aspect, the present invention provides a method for
inhibiting scarring comprising placing a cardiac pacemaker (i.e.,
an electrical device) and an anti-scarring agent or a composition
comprising an ant-scarring agent into an animal host, wherein the
agent inhibits scarring.
[0963] In certain embodiments, the cardiac pacemaker is an adaptive
rate pacemaker. In certain other embodiments, the cardiac pacemaker
is a rate responsive pacemaker.
[0964] 11. Implantable Cardioverter Defibrillator
[0965] In one aspect, the present invention provides a method for
inhibiting scarring comprising placing an implantable cardioverter
defibrillator (ICD) system (i.e., an electrical device) and an
anti-scarring agent or a composition comprising an ant-scarring
agent into an animal host, wherein the agent inhibits scarring.
[0966] Such a method may be further defined by one, two, or more of
the following features: the implantable cardioverter defibrillator
is adapted for treating tachyarraythmias; the implantable
cardioverter defibrillator is adapted for ventricular tachycardia;
the implantable cardioverter defibrillator is adapted for treating
ventricular fibrillation; the implantable cardioverter
defibrillator is adapted for treating atrial tachycardia; the
implantable cardioverter defibrillator is adapted for treating
atrial fibrillation; the implantable cardioverter defibrillator is
adapted for treating arrhythmias.
[0967] 12. Vagus Nerve Stimulator for Treating Arrhythemia
[0968] In one aspect, the present invention provides a method for
inhibiting scarring comprising placing a vagus nerve stimulator for
treating arrhythemia (i.e., an electrical device) and an
anti-scarring agent or a composition comprising an ant-scarring
agent into an animal host, wherein the agent inhibits scarring.
[0969] Such a method may be further defined by one, two or more of
the following features: the vagus nerve stimulator is adapted for
treating supraventricular arrhythmias; the vagus nerve stimulator
is adapted for treating angina pectoris; the vagus nerve stimulator
is adapted for treating atrial tachycardia; the vagus nerve
stimulator is adapted for treating atrial flutter; the vagus nerve
stimulator is adapted for treating arterial fibrillation; the vagus
nerve stimulator is arrhythmias that result in low cardiac output;
and the vagus nerve stimulator comprises a programmable pulse
generator.
[0970] 13. Electrical Lead
[0971] In one aspect, the present invention provides a method for
inhibiting scarring comprising placing an electrical lead (i.e., an
electrical device) and an anti-scarring agent or a composition
comprising an ant-scarring agent into an animal host, wherein the
agent inhibits scarring.
[0972] Such a method may be further defined by one, two or more of
the following features: the electrical lead comprises a connector
assembly, a conductor and an electrode; the electrical lead is
unipolar; the electrical lead is bipolar; the electrical lead is
tripolar; the electrical lead is quadripolar; the electrical lead
comprises an insulating sheath; the electrical lead is a medical
lead; the electrical lead is a cardiac lead; the electrical lead is
a pacer lead; the electrical lead is a pacing lead; the electrical
lead is a pacemaker lead; the electrical lead is an endocardial
lead; the electrical lead is an endocardial pacing lead; the
electrical lead is a cardioversion lead; the electrical lead is an
epicardial lead; the electrical lead is an epicardial defibrillator
lead; the electrical lead is a patch defibrillator; the electrical
lead is a patch lead; the electrical lead is an electrical patch;
the electrical lead is a transvenous lead; the electrical lead is
an active fixation lead; the electrical lead is a passive fixation
lead; the electrical lead is a sensing lead; the electrical lead is
expandable; the electrical lead has a coil configuration; and the
electrical lead has an active fixation element for attachment to
host tissue.
[0973] 14. Neurostimulator
[0974] In one aspect, the present invention provides a method for
inhibiting scarring comprising placing a neurostimulator (i.e., an
electrical device) and an anti-scarring agent or a composition
comprising an ant-scarring agent into an animal host, wherein the
agent inhibits scarring.
[0975] Such a method may be further defined by one, two or more of
the following features: the electrical device is a neurostimulator;
the electrical device is a spinal cord stimulator; the electrical
device is a brain stimulator; the electrical device is a vagus
nerve stimulator; the electrical device is a sacral nerve
stimulator; the electrical device is a gastric nerve stimulator;
the electrical device is an auditory nerve stimulator; the
electrical device delivers stimulation to organs; the electrical
device delivers stimulation to bone; the electrical device delivers
stimulation to muscles; the electrical device delivers stimulation
to tissues; the electrical device is a device for continuous
subarachnoid infusion; the electrical device is an implantable
electrode; the electrical device is an electrical lead; the
electrical device is a simulation catheter lead; the electrical
device is cochlear implant; the electrical device is a
microstimulator; the electrical device is battery powered; the
electrical device is radio frequency powered; the electrical device
is both battery and radio frequency powered; the electrical device
is adapted for treating or preventing pain; the electrical device
is adapted for treating or preventing epilepsy; the electrical
device is adapted for treating or preventing Parkinson's disease;
the electrical device is adapted for treating or preventing
movement disorders; the electrical device is adapted for treating
or preventing obesity; the electrical device is adapted for
treating or preventing depression; the electrical device is adapted
for treating or preventing anxiety; the electrical device is
adapted for treating or preventing hearing loss; the electrical
device is adapted for treating or preventing ulcers; the electrical
device is adapted for treating or preventing deep vein thrombosis;
the electrical device is adapted for treating or preventing
muscular atrophy; the electrical device is adapted for treating or
preventing joint stiffness; the electrical device is adapted for
treating or preventing muscle spasms; the electrical device is
adapted for treating or preventing osteoporosis; the electrical
device is adapted for treating or preventing scoliosis; the
electrical device is adapted for treating or preventing spinal disc
degeneration; the electrical device is adapted for treating or
preventing spinal cord injury; the electrical device is adapted for
treating or preventing urinary dysfunction; the electrical device
is adapted for treating or preventing gastroparesis; the electrical
device is adapted for treating or preventing malignancy; the
electrical device is adapted for treating or preventing
arachnoiditis; the electrical device is adapted for treating or
preventing chronic disease; the electrical device is adapted for
treating or preventing migraine; the electrical device is adapted
for treating or preventing sleep disorders; the electrical device
is adapted for treating or preventing dementia; and the electrical
device is adapted for treating or preventing Alzheimer's
disease.
[0976] 15. Cardiac Rhythm Management Device
[0977] In one aspect, the present invention provides a method for
inhibiting scarring comprising placing a cardiac rhythm management
device (i.e., an electrical device) and an anti-scarring agent or a
composition comprising an anti-scarring agent into an animal host,
wherein the agent inhibits scarring.
[0978] Such a method may be defined by one, two or more of the
following features: the electrical device is an implantable pulse
generator; the electrical device is an electrical lead; the
electrical device is a stimulation lead; the electrical device is a
simulation catheter lead; the electrical device is a
microstimulator; the electrical device is battery powered; the
electrical device is radio frequency powered; the electrical device
is both battery and radio frequency powered; the electrical device
is a cardiac pacemaker; the electrical device is an implantable
cardioverter defibrillator system; the electrical device is a
cardiac lead; the electrical device is a pacer lead; the electrical
device is an endocardial lead; the electrical device is a
cardioversion/defibrillator lead; the electrical device is an
epicardial lead; the electrical device is an epicardial
defibrillator lead; the electrical device is a patch defibrillator;
the electrical device is a patch defibrillator lead; the electrical
device is an electrical patch; the electrical device is a
transvenous lead; the electrical device is an active fixation lead;
the electrical device is a passive fixation lead; the electrical
device is a sensing lead; the electrical device is a defibrillator;
the electrical device is an implantable sensor; the electrical
device is a left ventricular assist device; the electrical device
is a pulse generator; the electrical device is a patch lead; the
electrical device is an electrical patch; the electrical device is
a cardiac stimulator; the electrical device is an electrical
deviceable sensor; the electrical device is an electrical
deviceable pump; the electrical device is a dural patch; the
electrical device is a ventricular peritoneal shunt; the electrical
device is a ventricular atrial shunt; the electrical device is
adapted for treating or preventing epidural fibrosis
post-laminectomy; the electrical device is adapted for treating or
preventing cardiac rhythm abnormalities; the electrical device is
adapted for treating or preventing atrial rhythm abnormalities; the
electrical device is adapted for treating or preventing conduction
abnormalities; and the electrical device is adapted for treating or
preventing ventricular rhythm abnormalities.
[0979] Additional Features Related to Methods for Inhibiting
Scarring
[0980] The methods for inhibiting scarring may also be further
defined by one, two, or more of the following features: the agent
inhibits cell regeneration; the agent inhibits angiogenesis; the
agent inhibits fibroblast migration; the agent inhibits fibroblast
proliferation; the agent inhibits deposition of extracellular
matrix; the agent inhibits tissue remodeling; the agent is an
angiogenesis inhibitor; the agent is a 5-lipoxygenase inhibitor or
antagonist; the agent is a chemokine receptor antagonist; the agent
is a cell cycle inhibitor; the agent is a taxane; the agent is an
anti-microtubule agent; the agent is paclitaxel; the agent is not
paclitaxel; the agent is an analogue or derivative of paclitaxel;
the agent is a vinca alkaloid; the agent is camptothecin or an
analogue or derivative thereof; the agent is a podophyllotoxin; the
agent is a podophyllotoxin, wherein the podophyllotoxin is
etoposide or an analogue or derivative thereof; the agent is an
anthracycline; the agent is an anthracycline, wherein the
anthracycline is doxorubicin or an analogue or derivative thereof;
the agent is an anthracycline, wherein the anthracycline is
mitoxantrone or an analogue or derivative thereof; the agent is a
platinum compound; the agent is a nitrosourea; the agent is a
nitroimidazole; the agent is a folic acid antagonist; the agent is
a cytidine analogue; the agent is a pyrimidine analogue; the agent
is a fluoropyrimidine analogue; the agent is a purine analogue; the
agent is a nitrogen mustard or an analogue or derivative thereof;
the agent is a hydroxyurea; the agent is a mytomicin or an analogue
or derivative thereof; the agent is an alkyl sulfonate; the agent
is a benzamide or an analogue or derivative thereof; the agent is a
nicotinamide or an analogue or derivative thereof; the agent is a
halogenated sugar or an analogue or derivative thereof; the agent
is a DNA alkylating agent; the agent is an anti-microtubule agent;
the agent is a topoisomerase inhibitor; the agent is a DNA cleaving
agent; the agent is an antimetabolite; the agent inhibits adenosine
deaminase; the agent inhibits purine ring synthesis; the agent is a
nucleotide interconversion inhibitor; the agent inhibits
dihydrofolate reduction; the agent blocks thymidine monophosphate;
the agent causes DNA damage; the agent is a DNA intercalation
agent; the agent is a RNA synthesis inhibitor; the agent is a
pyrimidine synthesis inhibitor; the agent inhibits ribonucleotide
synthesis or function; the agent inhibits thymidine monophosphate
synthesis or function; the agent inhibits DNA synthesis; the agent
causes DNA adduct formation; the agent inhibits protein synthesis;
the agent inhibits microtubule function; the agent is a cyclin
dependent protein kinase inhibitor; the agent is an epidermal
growth factor kinase inhibitor; the agent is an elastase inhibitor;
the agent is a factor Xa inhibitor; the agent is a
farnesyltransferase inhibitor; the agent is a fibrinogen
antagonist; the agent is a guanylate cyclase stimulant; the agent
is a heat shock protein 90 antagonist; the agent is a heat shock
protein 90 antagonist, wherein the heat shock protein 90 antagonist
is geldanamycin or an analogue or derivative thereof; the agent is
a guanylate cyclase stimulant; the agent is a HMGCoA reductase
inhibitor; the agent is a HMGCoA reductase inhibitor, wherein the
HMGCoA reductase inhibitor is simvastatin or an analogue or
derivative thereof; the agent is a hydroorotate dehydrogenase
inhibitor; the agent is an IKK2 inhibitor; the agent is an IL-1
antagonist; the agent is an ICE antagonist; the agent is an IRAK
antagonist; the agent is an IL-4 agonist; the agent is an
immunomodulatory agent; the agent is sirolimus or an analogue or
derivative thereof; the agent is not sirolimus; the agent is
everolimus or an analogue or derivative thereof; the agent is
tacrolimus or an analogue or derivative thereof; the agent is not
tacrolimus; the agent is biolmus or an analogue or derivative
thereof; the agent is tresperimus or an analogue or derivative
thereof; the agent is auranofin or an analogue or derivative
thereof; the agent is 27-0-demethylrapamycin or an analogue or
derivative thereof; the agent is gusperimus or an analogue or
derivative thereof; the agent is pimecrolimus or an analogue or
derivative thereof; the agent is ABT-578 or an analogue or
derivative thereof; the agent is an inosine monophosphate
dehydrogenase (IMPDH) inhibitor; the agent is an IMPDH inhibitor,
wherein the IMPDH inhibitor is mycophenolic acid or an analogue or
derivative thereof; the agent is an IMPDH inhibitor, wherein the
IMPDH inhibitor is 1-alpha-25 dihydroxy vitamin D.sub.3 or an
analogue or derivative thereof; the agent is a leukotriene
inhibitor; the agent is a MCP-1 antagonist; the agent is a MMP
inhibitor; the agent is an NF kappa B inhibitor; the agent is an NF
kappa B inhibitor, wherein the NF kappa B inhibitor is Bay 11-7082;
the agent is an NO antagonist; the agent is a p38 MAP kinase
inhibitor; the agent is a p38 MAP kinase inhibitor, wherein the p38
MAP kinase inhibitor is SB 202190; the agent is a phosphodiesterase
inhibitor; the agent is a TGF beta inhibitor; the agent is a
thromboxane A2 antagonist; the agent is a TNF.alpha. antagonist;
the agent is a TACE inhibitor; the agent is a tyrosine kinase
inhibitor; the agent is a vitronectin inhibitor; the agent is a
fibroblast growth factor inhibitor; the agent is a protein kinase
inhibitor; the agent is a PDGF receptor kinase inhibitor; the agent
is an endothelial growth factor receptor kinase inhibitor; the
agent is a retinoic acid receptor antagonist; the agent is a
platelet derived growth factor receptor kinase inhibitor; the agent
is a fibrinogen antagonist; the agent is an antimycotic agent; the
agent is an antimycotic agent, wherein the antimycotic agent is
sulconizole; the agent is a bisphosphonate; the agent is a
phospholipase A1 inhibitor; the agent is a histamine H1/H2/H3
receptor antagonist; the agent is a macrolide antibiotic; the agent
is a GPIIb/IIIa receptor antagonist; the agent is an endothelin
receptor antagonist; the agent is a peroxisome
proliferator-activated receptor agonist; the agent is an estrogen
receptor agent; the agent is a somastostatin analogue; the agent is
a neurokinin 1 antagonist; the agent is a neurokinin 3 antagonist;
the agent is a VLA-4 antagonist; the agent is an osteoclast
inhibitor; the agent is a DNA topoisomerase ATP hydrolyzing
inhibitor; the agent is an angiotensin I converting enzyme
inhibitor; the agent is an angiotensin II antagonist; the agent is
an enkephalinase inhibitor; the agent is a peroxisome
proliferator-activated receptor gamma agonist insulin sensitizer;
the agent is a protein kinase C inhibitor; the agent is a ROCK
(rho-associated kinase) inhibitor; the agent is a CXCR3 inhibitor;
the agent is an Itk inhibitor; the agent is a cytosolic
phospholipase A.sub.2-alpha inhibitor; the agent is a PPAR agonist;
the agent is an immunosuppressant; the agent is an Erb inhibitor;
the agent is an apoptosis agonist; the agent is a lipocortin
agonist; the agent is a VCAM-1 antagonist; the agent is a collagen
antagonist; the agent is an alpha 2 integrin antagonist; the agent
is a TNF alpha inhibitor; the agent is a nitric oxide inhibitor;
the agent is a cathepsin inhibitor; the agent is not an
anti-inflammatory agent; the agent is not a steroid; the agent is
not a glucocorticosteroid; the agent is not dexamethasone; the
agent is not beclomethasone; the agent is not dipropionate; the
agent is not an anti-infective agent; the agent is not an
antibiotic; the agent is not an anti-fungal agent; the composition
comprises a polymer; the composition comprises a polymer, and the
polymer is, or comprises, a copolymer; the composition comprises a
polymer, and the polymer is, or comprises, a block copolymer; the
composition comprises a polymer, and the polymer is, or comprises,
a random copolymer; the composition comprises a polymer, and the
polymer is, or comprises, a biodegradable polymer; the composition
comprises a polymer, and the polymer is, or comprises, a
non-biodegradable polymer; the composition comprises a polymer, and
the polymer is, or comprises, a hydrophilic polymer; the
composition comprises a polymer, and the polymer is, or comprises,
a hydrophobic polymer; the composition comprises a polymer, and the
polymer is, or comprises, a polymer having hydrophilic domains; the
composition comprises a polymer, and the polymer is, or comprises,
a polymer having hydrophobic domains; the composition comprises a
polymer, and the polymer is, or comprises, a non-conductive
polymer; the composition comprises a polymer, and the polymer is,
or comprises, an elastomer; the composition comprises a polymer,
and the polymer is, or comprises, a hydrogel; the composition
comprises a polymer, and the polymer is, or comprises, a silicone
polymer; the composition comprises a polymer, and the polymer is,
or comprises, a hydrocarbon polymer; the composition comprises a
polymer, and the polymer is, or comprises, a styrene-derived
polymer; the composition comprises a polymer, and the polymer is,
or comprises, a butadiene-derived polymer; the composition
comprises a polymer, and the polymer is, or comprises, a macromer;
the composition comprises a polymer, and the polymer is, or
comprises, a poly(ethylene glycol) polymer; the composition
comprises a polymer, and the polymer is, or comprises, an amorphous
polymer; the composition further comprises a second
pharmaceutically active agent; the composition further comprises an
anti-inflammatory agent; the composition further comprises an agent
that inhibits infection; the composition further comprises an
anthracycline; the composition further comprises doxorubicin; the
composition further comprises mitoxantrone; the composition further
comprises a fluoropyrimidine; the composition further comprises
5-fluorouracil (5-FU); the composition further comprises a folic
acid antagonist; the composition further comprises methotrexate;
the composition further comprises a podophylotoxin; the composition
further comprises etoposide; the composition further comprises
camptothecin; the composition further comprises a hydroxyurea; the
composition further comprises a platinum complex; the composition
further comprises cisplatin; the composition further comprises an
anti-thrombotic agent; the composition further comprises a
visualization agent; the composition further comprises a
visualization agent, and the visualization agent is a radiopaque
material, wherein the radiopaque material comprises a metal, a
halogenated compound, or a barium containing compound; the
composition further comprises a visualization agent, and the
visualization agent is, or comprises, barium, tantalum, or
technetium; the composition further comprises a visualization
agent, and the visualization agent is, or comprises, an MRI
responsive material; the composition further comprises a
visualization agent, and the visualization agent is, or comprises,
a gadolinium chelate; the composition further comprises a
visualization agent, and the visualization agent is, or comprises,
iron, magnesium, manganese, copper, or chromium; the composition
further comprises a visualization agent, and the visualization
agent is, or comprises, iron oxide compound; the composition
further comprises a visualization agent, and the visualization
agent is, or comprises, a dye, pigment, or colorant; the agent is
released in effective concentrations from the composition
comprising the agent by diffusion over a period ranging from the
time of administration to about 90 days; the agent is released in
effective concentrations from the composition comprising the agent
by erosion of the composition over a period ranging from the time
of administration to about 90 days; the composition further
comprises an inflammatory cytokine; the composition further
comprises an agent that stimulates cell proliferation; the
composition further comprises a polymeric carrier; the composition
is in the form of a gel, paste, or spray; the electrical device is
partially constructed with the agent or the composition; the
electrical device is impregnated with the agent or the composition;
the agent or the composition forms a coating, and the coating
directly contacts the electrical device; the agent or the
composition forms a coating, and the coating indirectly contacts
the electrical device; the agent or the composition forms a
coating, and the coating partially covers the electrical device;
the agent or the composition forms a coating, and the coating
completely covers the electrical device; the agent or the
composition is located within pores or holes of the electrical
device; the agent or the composition is located within a channel,
lumen, or divet of the electrical device; the electrical device
further comprises an echogenic material; the electrical device
further comprises an echogenic material, wherein the echogenic
material is in the form of a coating; the electrical device is
sterile; the agent is delivered from the electrical device, wherein
the agent is released into tissue in the vicinity of the electrical
device after deployment of the electrical device; the agent is
delivered from the electrical device, wherein the agent is released
into tissue in the vicinity of the electrical device after
deployment of the electrical device, wherein the tissue is
connective tissue; the agent is delivered from the electrical
device, wherein the agent is released into tissue in the vicinity
of the electrical device after deployment of the electrical device,
wherein the tissue is muscle tissue; the agent is delivered from
the electrical device, wherein the agent is released into tissue in
the vicinity of the electrical device after deployment of the
electrical device, wherein the tissue is nerve tissue; the agent is
delivered from the electrical device, wherein the agent is released
into tissue in the vicinity of the electrical device after
deployment of the electrical device, wherein the tissue is
epithelium tissue; the agent is delivered from the electrical
device, wherein the agent is released in effective concentrations
from the electrical device over a period ranging from the time of
deployment of the electrical device to about 1 year; the agent is
delivered from the electrical device, wherein the agent is released
in effective concentrations from the electrical device over a
period ranging from about 1 month to 6 months; the agent is
delivered from the electrical device, wherein the agent is released
in effective concentrations from the electrical device over a
period ranging from about 1-90 days; the agent is delivered from
the electrical device, wherein the agent is released in effective
concentrations from the electrical device at a constant rate; the
agent is delivered from the electrical device, wherein the agent is
released in effective concentrations from the electrical device at
an increasing rate; the agent is delivered from the electrical
device, wherein the agent is released in effective concentrations
from the electrical device at a decreasing rate; the agent is
delivered from the electrical device, wherein the electrical device
comprises about 0.01 .mu.g to about 10 .mu.g of the agent; the
agent is delivered from the electrical device, wherein the
electrical device comprises about 10 .mu.g to about 10 mg of the
agent; the agent is delivered from the electrical device, wherein
the electrical device comprises about 10 mg to about 250 mg of the
agent; the agent is delivered from the electrical device, wherein
the electrical device comprises about 250 mg to about 1000 mg of
the agent; the agent is delivered from the electrical device,
wherein the electrical device comprises about 1000 mg to about 2500
mg of the agent; the agent is delivered from the electrical device,
wherein a surface of the electrical device comprises less than 0.01
.mu.g of the agent per mm.sup.2 of electrical device surface to
which the agent is applied; the agent is delivered from the
electrical device, wherein a surface of the electrical device
comprises about 0.01 .mu.g to about 1 .mu.g of the agent per
mm.sup.2 of electrical device surface to which the agent is
applied; the agent is delivered from the electrical device, wherein
a surface of the electrical device comprises about 1 .mu.g to about
10 .mu.g of the agent per mm.sup.2 of electrical device surface to
which the agent is applied; the agent is delivered from the
electrical device, wherein a surface of the electrical device
comprises about 10 .mu.g to about 250 .mu.g of the agent per
mm.sup.2 of electrical device surface to which the agent is
applied; the agent is delivered from the electrical device, wherein
a surface of the electrical device comprises about 250 .mu.g to
about 1000 .mu.g of the agent per mm.sup.2 of electrical device
surface to which the agent is applied; the agent is delivered from
the electrical device, wherein a surface of the electrical device
comprises about 1000 .mu.g to about 2500 .mu.g of the agent per
mm.sup.2 of electrical device surface to which the agent is
applied; the electrical device further comprises a coating, and the
coating is a uniform coating; the electrical device further
comprises a coating, and the coating is a non-uniform coating; the
electrical device further comprises a coating, and the coating is a
discontinuous coating; the electrical device further comprises a
coating, and the coating is a patterned coating; the electrical
device further
comprises a coating, and the coating has a thickness of 100 .mu.m
or less; the electrical device further comprises a coating, and the
coating has a thickness of 10 .mu.m or less; the electrical device
further comprises a coating, and the coating adheres to the surface
of the electrical device upon deployment of the electrical device;
the electrical device further comprises a coating, and the coating
is stable at room temperature for a period of at least 1 year; the
electrical device further comprises a coating, and the agent is
present in the coating in an amount ranging between about 0.0001%
to about 1% by weight; the electrical device further comprises a
coating, and the agent is present in the coating in an amount
ranging between about 1% to about 10% by weight; the electrical
device further comprises a coating, and the agent is present in the
coating in an amount ranging between about 10% to about 25% by
weight; the electrical device further comprises a coating, and the
agent is present in the coating in an amount ranging between about
25% to about 70% by weight; the electrical device further comprises
a coating, and the coating comprises a polymer; the electrical
device comprises a first coating having a first composition and a
second coating having a second composition; the electrical device
comprises a first coating having a first composition and a second
coating having a second composition, wherein the first composition
and the second composition are different; the agent or the
composition is affixed to the electrical device; the agent or the
composition is covalently attached to the electrical device; the
agent or the composition is non-covalently attached to the
electrical device; the electrical device comprises a coating that
absorbs the agent or the composition; the electrical device is
interweaved with a thread composed of, or coated with, the agent or
the composition; a portion of the electrical device is covered with
a sleeve that contains the agent or the composition; the electrical
device is completely covered with a sleeve that contains the agent
or the composition; a portion of the electrical device is covered
with a mesh that contains the agent or the composition; the
electrical device is completely covered with a mesh that contains
the agent or the composition; the agent or the composition is
applied to the electrical device surface prior to the placing of
the electrical device into the host; the agent or the composition
is applied to the electrical device surface during the placing of
the electrical device into the host; the agent or the composition
is applied to the electrical device surface immediately after the
placing of the electrical device into the host; the agent or the
composition is applied to the surface of the tissue in the host
surrounding the electrical device prior to the placing of the
electrical device into the host; the agent or the composition is
applied to the surface of the tissue in the host surrounding the
electrical device during the placing of the electrical device into
the host; the agent or the composition is applied to the surface of
the tissue in the host surrounding the electrical device
immediately after the placing of the electrical device into the
host; the agent or the composition is topically applied into the
anatomical space where the electrical device is placed; and the
agent or the composition is percutaneously injected into the tissue
in the host surrounding the electrical device.
[0981] The present invention, in various aspects and embodiments,
provides the following methods for making medical devices:
[0982] 1. Electrical Device
[0983] In one aspect, the present invention provides a method for
making a medical device comprising: combining an electrical device
and an anti-scarring agent or a composition comprising an
anti-scarring agent, wherein the agent inhibits scarring between
the device and a host into which the device is implanted.
[0984] Such a method may be defined by one, two, or more of the
following features: the electrical device is a neurostimulator; the
electrical device is a spinal cord stimulator; the electrical
device is a brain stimulator; the electrical device is a vagus
nerve stimulator; the electrical device is a sacral nerve
stimulator; the electrical device is a gastric nerve stimulator;
the electrical device is an auditory nerve stimulator; the
electrical device delivers stimulation to organs; the electrical
device delivers stimulation to bone; the electrical device delivers
stimulation to muscles; the electrical device delivers stimulation
to tissues; the electrical device is a device for continuous
subarachnoid infusion; the electrical device is an implantable
electrode; the electrical device is an implantable pulse generator;
the electrical device is an electrical lead; the electrical device
is a stimulation lead; the electrical device is a simulation
catheter lead; the electrical device is cochlear implant; the
electrical device is a microstimulator; the electrical device is
battery powered; the electrical device is radio frequency powered;
the electrical device is both battery and radio frequency powered;
the electrical device is a cardiac rhythm management device; the
electrical device is a cardiac pacemaker; the electrical device is
an implantable cardioverter defibrillator system; the electrical
device is a cardiac lead; the electrical device is a pacer lead;
the electrical device is an endocardial lead; the electrical device
is a cardioversion/defibrillator lead; the electrical device is an
epicardial lead; the electrical device is an epicardial
defibrillator lead; the electrical device is a patch defibrillator;
the electrical device is a patch defibrillator lead; the electrical
device is an electrical patch; the electrical device is a
transvenous lead; the electrical device is an active fixation lead;
the electrical device is a passive fixation lead; the electrical
device is a sensing lead; the electrical device is a defibrillator;
the electrical device is an implantable sensor; the electrical
device is a left ventricular assist device; the electrical device
is a pulse generator; the electrical device is a patch lead; the
electrical device is an electrical patch; the electrical device is
a cardiac stimulator; the electrical device is an electrical
deviceable sensor; the electrical device is an electrical
deviceable pump; the electrical device is a dural patch; the
electrical device is a ventricular peritoneal shunt; the electrical
device is a ventricular atrial shunt; the electrical device is
adapted for treating or preventing epidural fibrosis
post-laminectomy; the electrical device is adapted for treating or
preventing cardiac rhythm abnormalities; the electrical device is
adapted for treating or preventing atrial rhythm abnormalities; the
electrical device is adapted for treating or preventing conduction
abnormalities; the electrical device is adapted for treating or
preventing ventricular rhythm abnormalities; the electrical device
is adapted for treating or preventing pain; the electrical device
is adapted for treating or preventing epilepsy; the electrical
device is adapted for treating or preventing Parkinson's disease;
the electrical device is adapted for treating or preventing
movement disorders; the electrical device is adapted for treating
or preventing obesity; the electrical device is adapted for
treating or preventing depression; the electrical device is adapted
for treating or preventing anxiety; the electrical device is
adapted for treating or preventing hearing loss; the electrical
device is adapted for treating or preventing ulcers; the electrical
device is adapted for treating or preventing deep vein thrombosis;
the electrical device is adapted for treating or preventing
muscular atrophy; the electrical device is adapted for treating or
preventing joint stiffness; the electrical device is adapted for
treating or preventing muscle spasms; the electrical device is
adapted for treating or preventing osteoporosis; the electrical
device is adapted for treating or preventing scoliosis; the
electrical device is adapted for treating or preventing spinal disc
degeneration; the electrical device is adapted for treating or
preventing spinal cord injury; the electrical device is adapted for
treating or preventing urinary dysfunction; the electrical device
is adapted for treating or preventing gastroparesis; the electrical
device is adapted for treating or preventing malignancy; the
electrical device is adapted for treating or preventing
arachnoiditis; the electrical device is adapted for treating or
preventing chronic disease; the electrical device is adapted for
treating or preventing migraine; the electrical device is adapted
for treating or preventing sleep disorders; the electrical device
is adapted for treating or preventing dementia; and the electrical
device is adapted for treating or preventing Alzheimer's
disease.
[0985] 2. Neurostimulator for Treating Chronic Pain
[0986] In one aspect, the present invention provides a method for
making a medical device comprising: combining a neurostimulator for
treating chronic pain (i.e., an electrical device) and an
anti-scarring agent or a composition comprising an anti-scarring
agent, wherein the agent inhibits scarring between the device and a
host into which the device is implanted.
[0987] Such a method may be further defined by one, two, or more of
the following features: the chronic pain results from injury; the
chronic pain results from an illness; the chronic pain results from
scoliosis; the chronic pain results from spinal disc degeneration;
the chronic pain results from malignancy; the chronic pain results
from arachnoiditis; the chronic pain results from a chronic
disease; the chronic pain results from a pain syndrome; the
neurostimulator comprises a lead that delivers electrical
stimulation to a nerve and an electrical connection that connects a
power source to the lead; the neurostimulator is adapted for spinal
cord stimulation, and comprises a sensor that detects the position
of the spine and a stimulator that emits pulses that decrease in
amplitude when the back is in a supine position; the
neurostimulator comprises an electrode and a control circuit that
generates pulses and rest period based on intervals corresponding
to the host body's activity and regeneration period; the
neurostimulator comprises a stimulation catheter lead and an
electrode; and the neurostimulator is a self-centering epidural
spinal cord lead.
[0988] 3. Neurostimulator for Treating Parkinson's Disease
[0989] In one aspect, the present invention provides a method for
making a medical device comprising: combining a neurostimulator for
treating Parkinson's Disease (i.e., an electrical device) and an
anti-scarring agent or a composition comprising an anti-scarring
agent, wherein the agent inhibits scarring between the device and a
host into which the device is implanted.
[0990] In certain embodiments, the neurostimulator comprises an
intracranially implantable electrical control module and an
electrode. In other embodiments, the neurostimulator comprises a
sensor and an electrode.
[0991] 4. Vagal Nerve Stimulator for Treating Epilepsy
[0992] In one aspect, the present invention provides a method for
making a medical device comprising: combining a vagal nerve
stimulator for treating epilepsy (i.e., an electrical device) and
an anti-scarring agent or a composition comprising an anti-scarring
agent, wherein the agent inhibits scarring between the device and a
host into which the device is implanted.
[0993] 5. Vagal Nerve Stimulator for Treating Other Disorders
[0994] In one aspect, the present invention provides a method for
making a medical device comprising: combining a vagal nerve
stimulator (i.e., an electrical device) and an anti-scarring agent
or a composition comprising an anti-scarring agent, wherein the
agent inhibits scarring between the device and a host into which
the device is implanted.
[0995] Such a method may be further defined by one, two or more of
the following features: the vagal nerve stimulator is adapted for
treating or preventing depression; the vagal nerve stimulator is
adapted for treating or preventing anxiety; the vagal nerve
stimulator is adapted for treating or preventing panic disorders;
the vagal nerve stimulator is adapted for treating or preventing
obsessive-compulsive disorders; the vagal nerve stimulator is
adapted for treating or preventing post-traumatic disorders; the
vagal nerve stimulator is adapted for treating or preventing
obesity; the vagal nerve stimulator is adapted for treating or
preventing migraine; the vagal nerve stimulator is adapted for
treating or preventing sleep disorders; the vagal nerve stimulator
is adapted for treating or preventing dementia; the vagal nerve
stimulator is adapted for treating or preventing Alzheimer's
disease; and the vagal nerve stimulator is adapted for treating or
preventing chronic or degenerative neurological disorders.
[0996] 6. Sacral Nerve Stimulator
[0997] In one aspect, the present invention provides a method for
making a medical device comprising: combining a sacral nerve
stimulator for treating a bladder control problem (i.e., an
electrical device) and an anti-scarring agent or a composition
comprising an anti-scarring agent, wherein the agent inhibits
scarring between the device and a host into which the device is
implanted.
[0998] Such a method may be further defined by one, two, or more of
the following features: the sacral nerve stimulator is adapted for
treating or preventing urge incontinence; the sacral nerve
stimulator is adapted for treating or preventing nonobstructive
urinary retention; the sacral nerve stimulator is adapted for
treating or preventing urgency frequency; the sacral nerve
stimulator is an intramuscular electrical stimulator; and the
sacral nerve stimulator is a leadless, tubular-shaped
microstimulator.
[0999] 7. Gastric Nerve Stimulator
[1000] In one aspect, the present invention provides a method for
making a medical device comprising: combining a gastric nerve
stimulator for treating a gastrointestinal disorder (i.e., an
electrical device) and an anti-scarring agent or a composition
comprising an anti-scarring agent, wherein the agent inhibits
scarring between the device and a host into which the device is
implanted.
[1001] Such a method may be further defined by one, two, or more of
the following features: the gastric nerve stimulator is adapted for
treating or preventing morbid obesity; the gastric nerve stimulator
is adapted for treating or preventing constipation; the gastric
nerve stimulator comprises an electrical lead, an electrode and a
stimulation generator; and the gastric nerve stimulator comprises
an electrical signal controller, connector wire and an attachment
lead.
[1002] 8. Cochlear Implant
[1003] The present invention provides a method for making a medical
device comprising: combining a cochlear implant for treating
deafness (i.e., an electrical device) and an anti-scarring agent or
a composition comprising an anti-scarring agent, wherein the agent
inhibits scarring between the device and a host into which the
device is implanted.
[1004] Such a method may be further defined by one, two or more the
following features: the cochlear implant comprises a plurality of
transducer elements; the cochlear implant comprises a
sound-to-electrical stimulation encoder, a body implantable
receiver-stimulator, and electrodes; the cochlear implant comprises
a transducer and an electrode array; and the cochlear implant is a
subcranially implantable electomechanical system.
[1005] 9. Bone Growth Stimulator
[1006] In one aspect, the present invention provides a method for
making a medical device comprising: combining a bone growth
stimulator (i.e., an electrical device) and an anti-scarring agent
or a composition comprising an anti-scarring agent, wherein the
agent inhibits scarring between the device and a host into which
the device is implanted.
[1007] In certain embodiments, the bone growth stimulator comprises
an electrode and a generator having a strain response piezoelectric
material that responds to strain.
[1008] 10. Cardiac Pacemaker
[1009] In one aspect, the present invention provides a method for
making a medical device comprising: combining a cardiac pacemaker
(i.e., an electrical device) and an anti-scarring agent or a
composition comprising an anti-scarring agent, wherein the agent
inhibits scarring between the device and a host into which the
device is implanted.
[1010] In certain embodiments, the cardiac pacemaker is an adaptive
rate pacemaker. In certain other embodiments, the cardiac pacemaker
is a rate responsive pacemaker.
[1011] 11. Implantable Cardioverter Defibrillator
[1012] In one aspect, the present invention provides a method for
making a medical device comprising: combining an implantable
cardioverter defibrillator (ICD) system (i.e., an electrical
device) and an anti-scarring agent or a composition comprising an
anti-scarring agent, wherein the agent inhibits scarring between
the device and a host into which the device is implanted.
[1013] Such a method may be further defined by one, two, or more of
the following features: the implantable cardioverter defibrillator
is adapted for treating tachyarraythmias; the implantable
cardioverter defibrillator is adapted for ventricular tachycardia;
the implantable cardioverter defibrillator is adapted for treating
ventricular fibrillation; the implantable cardioverter
defibrillator is adapted for treating atrial tachycardia; the
implantable cardioverter defibrillator is adapted for treating
atrial fibrillation; the implantable cardioverter defibrillator is
adapted for treating arrhythmias.
[1014] 12. Vagus Nerve Stimulator for Treating Arrhythemia
[1015] In one aspect, the present invention provides a method for
making a medical device comprising: combining a vagus nerve
stimulator for treating arrhythemia (i.e., an electrical device)
and an anti-scarring agent or a composition comprising an
anti-scarring agent, wherein the agent inhibits scarring between
the device and a host into which the device is implanted.
[1016] Such a method may be further defined by one, two or more of
the following features: the vagus nerve stimulator is adapted for
treating supraventricular arrhythmias; the vagus nerve stimulator
is adapted for treating angina pectoris; the vagus nerve stimulator
is adapted for treating atrial tachycardia; the vagus nerve
stimulator is adapted for treating atrial flutter; the vagus nerve
stimulator is adapted for treating arterial fibrillation; the vagus
nerve stimulator is arrhythmias that result in low cardiac output;
and the vagus nerve stimulator comprises a programmable pulse
generator.
[1017] 13. Electrical Lead
[1018] In one aspect, the present invention provides a method for
making a medical device comprising: combining an electrical lead
(i.e., an electrical device) and an anti-scarring agent or a
composition comprising an anti-scarring agent, wherein the agent
inhibits scarring between the device and a host into which the
device is implanted.
[1019] Such a method may be further defined by one, two or more of
the following features: the electrical lead comprises a connector
assembly, a conductor and an electrode; the electrical lead is
unipolar; the electrical lead is bipolar; the electrical lead is
tripolar; the electrical lead is quadripolar; the electrical lead
comprises an insulating sheath; the electrical lead is a medical
lead; the electrical lead is a cardiac lead; the electrical lead is
a pacer lead; the electrical lead is a pacing lead; the electrical
lead is a pacemaker lead; the electrical lead is an endocardial
lead; the electrical lead is an endocardial pacing lead; the
electrical lead is a cardioversion lead; the electrical lead is an
epicardial lead; the electrical lead is an epicardial defibrillator
lead; the electrical lead is a patch defibrillator; the electrical
lead is a patch lead; the electrical lead is an electrical patch;
the electrical lead is a transvenous lead; the electrical lead is
an active fixation lead; the electrical lead is a passive fixation
lead; the electrical lead is a sensing lead; the electrical lead is
expandable; the electrical lead has a coil configuration; and the
electrical lead has an active fixation element for attachment to
host tissue.
[1020] 14. Neurostimulator
[1021] In one aspect, the present invention provides a method for
making a medical device comprising: combining a neurostimulator
(i.e., an electrical device) and an anti-scarring agent or a
composition comprising an anti-scarring agent, wherein the agent
inhibits scarring between the device and a host into which the
device is implanted.
[1022] Such a method may be further defined by one, two or more of
the following features: the electrical device is a neurostimulator;
the electrical device is a spinal cord stimulator; the electrical
device is a brain stimulator; the electrical device is a vagus
nerve stimulator; the electrical device is a sacral nerve
stimulator; the electrical device is a gastric nerve stimulator;
the electrical device is an auditory nerve stimulator; the
electrical device delivers stimulation to organs; the electrical
device delivers stimulation to bone; the electrical device delivers
stimulation to muscles; the electrical device delivers stimulation
to tissues; the electrical device is a device for continuous
subarachnoid infusion; the electrical device is an implantable
electrode; the electrical device is an electrical lead; the
electrical device is a simulation catheter lead; the electrical
device is cochlear implant; the electrical device is a
microstimulator; the electrical device is battery powered; the
electrical device is radio frequency powered; the electrical device
is both battery and radio frequency powered; the electrical device
is adapted for treating or preventing pain; the electrical device
is adapted for treating or preventing epilepsy; the electrical
device is adapted for treating or preventing Parkinson's disease;
the electrical device is adapted for treating or preventing
movement disorders; the electrical device is adapted for treating
or preventing obesity; the electrical device is adapted for
treating or preventing depression; the electrical device is adapted
for treating or preventing anxiety; the electrical device is
adapted for treating or preventing hearing loss; the electrical
device is adapted for treating or preventing ulcers; the electrical
device is adapted for treating or preventing deep vein thrombosis;
the electrical device is adapted for treating or preventing
muscular atrophy; the electrical device is adapted for treating or
preventing joint stiffness; the electrical device is adapted for
treating or preventing muscle spasms; the electrical device is
adapted for treating or preventing osteoporosis; the electrical
device is adapted for treating or preventing scoliosis; the
electrical device is adapted for treating or preventing spinal disc
degeneration; the electrical device is adapted for treating or
preventing spinal cord injury; the electrical device is adapted for
treating or preventing urinary dysfunction; the electrical device
is adapted for treating or preventing gastroparesis; the electrical
device is adapted for treating or preventing malignancy; the
electrical device is adapted for treating or preventing
arachnoiditis; the electrical device is adapted for treating or
preventing chronic disease; the electrical device is adapted for
treating or preventing migraine; the electrical device is adapted
for treating or preventing sleep disorders; the electrical device
is adapted for treating or preventing dementia; and the electrical
device is adapted for treating or preventing Alzheimer's
disease.
[1023] 15. Cardiac Rhythm Management Device
[1024] In one aspect, the present invention provides a method for
making a medical device comprising: combining a cardiac rhythm
management device (i.e., an electrical device) and an anti-scarring
agent or a composition comprising an anti-scarring agent, wherein
the agent inhibits scarring between the device and a host into
which the device is implanted.
[1025] Such a method may be defined by one, two or more of the
following features: the electrical device is an implantable pulse
generator; the electrical device is an electrical lead; the
electrical device is a stimulation lead; the electrical device is a
simulation catheter lead; the electrical device is a
microstimulator; the electrical device is battery powered; the
electrical device is radio frequency powered; the electrical device
is both battery and radio frequency powered; the electrical device
is a cardiac pacemaker; the electrical device is an implantable
cardioverter defibrillator system; the electrical device is a
cardiac lead; the electrical device is a pacer lead; the electrical
device is an endocardial lead; the electrical device is a
cardioversion/defibrillator lead; the electrical device is an
epicardial lead; the electrical device is an epicardial
defibrillator lead; the electrical device is a patch defibrillator;
the electrical device is a patch defibrillator lead; the electrical
device is an electrical patch; the electrical device is a
transvenous lead; the electrical device is an active fixation lead;
the electrical device is a passive fixation lead; the electrical
device is a sensing lead; the electrical device is a defibrillator;
the electrical device is an implantable sensor; the electrical
device is a left ventricular assist device; the electrical device
is a pulse generator; the electrical device is a patch lead; the
electrical device is an electrical patch; the electrical device is
a cardiac stimulator; the electrical device is an electrical
deviceable sensor; the electrical device is an electrical
deviceable pump; the electrical device is a dural patch; the
electrical device is a ventricular peritoneal shunt; the electrical
device is a ventricular atrial shunt; the electrical device is
adapted for treating or preventing epidural fibrosis
post-laminectomy; the electrical device is adapted for treating or
preventing cardiac rhythm abnormalities; the electrical device is
adapted for treating or preventing atrial rhythm abnormalities; the
electrical device is adapted for treating or preventing conduction
abnormalities; and the electrical device is adapted for treating or
preventing ventricular rhythm abnormalities.
[1026] In certain embodiments, the combining comprises (a)
assembling or providing an electrical lead having an electrode; (b)
mixing an anti-scarring agent with an organic solvent to form a
solution; (c) applying the solution to the electrical lead; and (d)
drying the solution on the electrical lead to remove the organic
solvent.
[1027] In certain embodiments, the combining comprises (a)
assembling or providing an electrical lead having an electrode; (b)
mixing an anti-scarring agent with an organic solvent to form a
solution; (c) applying the solution to the electrode; and (d)
drying the solution on the lead to remove the organic solvent.
[1028] In certain embodiments, the combining comprises (a)
assembling or providing an electrical lead having a porous
electrode tip; (b) mixing an anti-scarring agent with an organic
solvent to form a solution; (c) applying the solution to the porous
electrode tip; and (d) drying the solution on the electrical lead
to remove the organic solvent.
[1029] In certain embodiments, the combining comprises (a)
assembling or providing an electrical lead having an electrode; (b)
mixing an anti-scarring agent with an organic solvent to form a
solution; (c) applying the solution to the electrical lead; (d)
drying the solution on the electrical lead to remove the organic
solvent; and (e) sterilizing the electrical lead resulting from
(d).
[1030] In certain embodiments, the combining comprises (a)
assembling or providing an electrical lead having an electrode; (b)
mixing an anti-scarring agent with an organic solvent to form a
solution; (c) applying the solution to the electrode; (d) drying
the solution on the lead to remove the organic solvent; and (e)
sterilizing the electrical lead resulting from (d).
[1031] In certain embodiments, the combining comprises (a)
assembling or providing an electrical lead having a porous
electrode tip; (b) mixing an anti-scarring agent with an organic
solvent to form a solution; (c) applying the solution to the porous
electrode tip; (d) drying the solution on the electrical lead to
remove the organic solvent; and (e) sterilizing the electrical lead
resulting from (d).
[1032] In certain embodiments, the combining comprises (a)
assembling or providing an electrical lead having an electrode; (b)
mixing an anti-scarring agent with an organic solvent to form a
solution; (c) applying the solution to the electrical lead; (d)
drying the solution on the electrical lead to remove the organic
solvent; (e) packaging the lead resulting from (d); and (f)
sterilizing the packaged lead resulted from (e).
[1033] In certain embodiments, the combining comprises (a)
assembling or providing an electrical lead having an electrode; (b)
mixing an anti-scarring agent with an organic solvent to form a
solution; (c) applying the solution to the electrode; (d) drying
the solution on the lead to remove the organic solvent; (e)
packaging the lead; and (f) sterilizing the packaged lead resulting
from (e).
[1034] In certain embodiments, the combining comprises (a)
assembling or providing an electrical lead having a porous
electrode tip; (b) mixing an anti-scarring agent with an organic
solvent to form a solution; (c) applying the solution to the porous
electrode tip; (d) drying the solution on the electrical lead to
remove the organic solvent; (e) packaging the electrical lead
resulting from (d); and (f) sterilizing the packaged electrical
lead resulting from (e).
[1035] In certain embodiments, the combining comprises (a)
assembling or providing an electrical lead having an electrode; (b)
mixing an anti-scarring agent and an anti-inflammatory agent with
an organic solvent to form a solution; (c) applying the solution to
the lead; and (e) drying the solution on the electrical lead to
remove the organic solvent.
[1036] In certain embodiments, the combining comprises (a)
assembling or providing an electrical lead having an electrode; (b)
mixing an anti-scarring agent and an anti-inflammatory agent with
an organic solvent to form a solution; (c) applying the solution to
the electrode; and (d) drying the solution on the electrical lead
to remove the organic solvent.
[1037] In certain embodiments, the combining comprises: (a)
assembling or providing an electrical lead having a porous
electrode tip; (b) mixing an anti-scarring agent and an
anti-inflammatory agent with an organic solvent to form a solution;
(c) applying the solution to the porous electrode tip; and (d)
drying the solution on the electrical lead to remove the organic
solvent.
[1038] In certain embodiments, the combining comprises: (a)
assembling or providing a lead having an electrode; (b) mixing an
anti-scarring agent and an anti-inflammatory agent with an organic
solvent to form a solution; (c) applying the solution to the
electrical lead; (d) drying the solution on the lead to remove the
organic solvent; and (e) sterilizing the electrical lead resulting
from (d).
[1039] In certain embodiments, the combining comprises: (a)
assembling or providing an electrical lead having an electrode; (b)
mixing an anti-scarring agent and an anti-inflammatory agent with
an organic solvent to form a solution; (c) applying the solution to
the electrode; (d) drying the solution on the electrical lead to
remove the organic solvent; and (e) sterilizing the electrical lead
resulting from (d).
[1040] In certain embodiments, the combining comprises: (a)
assembling or providing an electrical lead having a porous
electrode tip; (b) mixing an anti-scarring agent and an
anti-inflammatory agent with an organic solvent to form a solution;
(c) applying the solution to the porous electrode tip; (d) drying
the solution on the electrical lead to remove the organic solvent;
and (e) sterilizing the electrical lead resulting from (d).
[1041] In certain embodiments, the combining comprises: (a)
assembling or providing a lead having an electrode; (b) mixing an
anti-scarring agent and an anti-inflammatory agent with an organic
solvent to form a solution; (c) applying the solution to the
electrical lead; (d) drying the solution on the lead to remove the
organic solvent; (e) packaging the electrical lead resulting from
(d); and (f) sterilizing the packaged electrical lead resulting
from (e).
[1042] In certain embodiments, the combining comprises: (a)
assembling or providing an electrical lead having an electrode; (b)
mixing an anti-scarring agent and an anti-inflammatory agent with
an organic solvent to form a solution; (c) applying the solution to
the electrode; (d) drying the solution on the electrical lead to
remove the organic solvent; (e) packaging the electrical lead
resulting from (d); and (f) sterilizing the packaged electrical
lead resulting from (e).
[1043] In certain embodiments, the combining comprises: (a)
assembling or providing an electrical lead having a porous
electrode tip; (b) mixing an anti-scarring agent and an
anti-inflammatory agent with an organic solvent to form a solution;
(c) applying the solution to the porous electrode tip; (d) drying
the solution on the electrical lead to remove the organic solvent;
(e) packaging the electrical lead resulting from (d); and (f)
sterilizing the packaged electrical lead resulting from (e).
[1044] In certain embodiments, the combining comprises (a)
assembling or providing an electrical lead having an electrode; (b)
mixing an anti-scarring agent and an anti-inflammatory agent with
an organic solvent to form a solution; (c) applying the solution to
the lead; and (d) drying the solution on the electrical lead to
remove the organic solvent; and wherein the anti-inflammatory agent
is a steroid.
[1045] In certain embodiments, the combining comprises (a)
assembling or providing an electrical lead having an electrode; (b)
mixing an anti-scarring agent and an anti-inflammatory agent with
an organic solvent to form a solution; (c) applying the solution to
the electrode; and (d) drying the solution on the electrical lead
to remove the organic solvent; and wherein the anti-inflammatory
agent is a steroid.
[1046] In certain embodiments, the combining comprises: (a)
assembling or providing an electrical lead having a porous
electrode tip; (b) mixing an anti-scarring agent and an
anti-inflammatory agent with an organic solvent to form a solution;
(c) applying the solution to the porous electrode tip; and (d)
drying the solution on the electrical lead to remove the organic
solvent; and wherein the anti-inflammatory agent is a steroid.
[1047] In certain embodiments, the combining comprises: (a)
assembling or providing a lead having an electrode; (b) mixing an
anti-scarring agent and an anti-inflammatory agent with an organic
solvent to form a solution; (c) applying the solution to the
electrical lead; (d) drying the solution on the lead to remove the
organic solvent; and (e) sterilizing the electrical lead resulting
from (d); and wherein the anti-inflammatory agent is a steroid.
[1048] In certain embodiments, the combining comprises: (a)
assembling or providing an electrical lead having an electrode; (b)
mixing an anti-scarring agent and an anti-inflammatory agent with
an organic solvent to form a solution; (c) applying the solution to
the electrode; (d) drying the solution on the electrical lead to
remove the organic solvent; and (e) sterilizing the electrical lead
resulting from (d); and wherein the anti-inflammatory agent is a
steroid.
[1049] In certain embodiments, the combining comprises: (a)
assembling or providing an electrical lead having a porous
electrode tip; (b) mixing an anti-scarring agent and an
anti-inflammatory agent with an organic solvent to form a solution;
(c) applying the solution to the porous electrode tip; (d) drying
the solution on the electrical lead to remove the organic solvent;
and (e) sterilizing the electrical lead resulting from (d); and
wherein the anti-inflammatory agent is a steroid.
[1050] In certain embodiments, the combining comprises: (a)
assembling or providing a lead having an electrode; (b) mixing an
anti-scarring agent and an anti-inflammatory agent with an organic
solvent to form a solution; (c) applying the solution to the
electrical lead; (d) drying the solution on the lead to remove the
organic solvent; (e) packaging the electrical lead resulting from
(d); and (f) sterilizing the packaged electrical lead resulting
from (e); and wherein the anti-inflammatory agent is a steroid.
[1051] In certain embodiments, the combining comprises: (a)
assembling or providing an electrical lead having an electrode; (b)
mixing an anti-scarring agent and an anti-inflammatory agent with
an organic solvent to form a solution; (c) applying the solution to
the electrode; (d) drying the solution on the electrical lead to
remove the organic solvent; (e) packaging the electrical lead
resulting from (d); and (f) sterilizing the packaged electrical
lead resulting from (e); and wherein the anti-inflammatory agent is
a steroid.
[1052] In certain embodiments, the combining comprises: (a)
assembling or providing an electrical lead having a porous
electrode tip; (b) mixing an anti-scarring agent and an
anti-inflammatory agent with an organic solvent to form a solution;
(c) applying the solution to the porous electrode tip; (d) drying
the solution on the electrical lead to remove the organic solvent;
(e) packaging the electrical lead resulting from (d); and (f)
sterilizing the packaged electrical lead resulting from (e); and
wherein the anti-inflammatory agent is a steroid.
[1053] In certain embodiments, the combining comprises (a)
assembling or providing an electrical lead having an electrode; (b)
mixing an anti-scarring agent and an anti-inflammatory agent with
an organic solvent to form a solution; (c) applying the solution to
the lead; and (d) drying the solution on the electrical lead to
remove the organic solvent; and wherein the anti-inflammatory is
selected from the group consisting of medrysone, desoximetasone,
triamcinolone, fluoromethalone, flurandrenolide, halcinonide,
betamethasone benzoate, triamicinolone acetonide, diflorasone
diacetate, betamethasone valerate, dexamethasone, and
beclomethasone dipropionate anhydrous.
[1054] In certain embodiments, the combining comprises (a)
assembling or providing an electrical lead having an electrode; (b)
mixing an anti-scarring agent and an anti-inflammatory agent with
an organic solvent to form a solution; (c) applying the solution to
the electrode; and (d) drying the solution on the electrical lead
to remove the organic solvent; and wherein the anti-inflammatory is
selected from the group consisting of medrysone, desoximetasone,
triamcinolone, fluoromethalone, flurandrenolide, halcinonide,
betamethasone benzoate, triamicinolone acetonide, diflorasone
diacetate, betamethasone valerate, dexamethasone, and
beclomethasone dipropionate anhydrous.
[1055] In certain embodiments, the combining comprises: (a)
assembling or providing an electrical lead having a porous
electrode tip; (b) mixing an anti-scarring agent and an
anti-inflammatory agent with an organic solvent to form a solution;
(c) applying the solution to the porous electrode tip; and (d)
drying the solution on the electrical lead to remove the organic
solvent; and wherein the anti-inflammatory is selected from the
group consisting of medrysone, desoximetasone, triamcinolone,
fluoromethalone, flurandrenolide, halcinonide, betamethasone
benzoate, triamicinolone acetonide, diflorasone diacetate,
betamethasone valerate, dexamethasone, and beclomethasone
dipropionate anhydrous.
[1056] In certain embodiments, the combining comprises: (a)
assembling or providing a lead having an electrode; (b) mixing an
anti-scarring agent and an anti-inflammatory agent with an organic
solvent to form a solution; (c) applying the solution to the
electrical lead; (d) drying the solution on the lead to remove the
organic solvent; and (e) sterilizing the electrical lead resulting
from (d); and wherein the anti-inflammatory is selected from the
group consisting of medrysone, desoximetasone, triamcinolone,
fluoromethalone, flurandrenolide, halcinonide, betamethasone
benzoate, triamicinolone acetonide, diflorasone diacetate,
betamethasone valerate, dexamethasone, and beclomethasone
dipropionate anhydrous.
[1057] In certain embodiments, the combining comprises: (a)
assembling or providing an electrical lead having an electrode; (b)
mixing an anti-scarring agent and an anti-inflammatory agent with
an organic solvent to form a solution; (c) applying the solution to
the electrode; (d) drying the solution on the electrical lead to
remove the organic solvent; and (e) sterilizing the electrical lead
resulting from (d); and wherein the anti-inflammatory is selected
from the group consisting of medrysone, desoximetasone,
triamcinolone, fluoromethalone, flurandrenolide, halcinonide,
betamethasone benzoate, triamicinolone acetonide, diflorasone
diacetate, betamethasone valerate, dexamethasone, and
beclomethasone dipropionate anhydrous.
[1058] In certain embodiments, the combining comprises: (a)
assembling an electrical lead having a porous electrode tip; (b)
mixing an anti-scarring agent and an anti-inflammatory agent with
an organic solvent to form a solution; (c) applying the solution to
the porous electrode tip; (d) drying the solution on the electrical
lead to remove the organic solvent; and (e) sterilizing the
electrical lead resulting from (d); and wherein the
anti-inflammatory is selected from the group consisting of
medrysone, desoximetasone, triamcinolone, fluoromethalone,
flurandrenolide, halcinonide, betamethasone benzoate,
triamicinolone acetonide, diflorasone diacetate, betamethasone
valerate, dexamethasone, and beclomethasone dipropionate
anhydrous.
[1059] In certain embodiments, the combining comprises: (a)
assembling or providing a lead having an electrode; (b) mixing an
anti-scarring agent and an anti-inflammatory agent with an organic
solvent to form a solution; (c) applying the solution to the
electrical lead; (d) drying the solution on the lead to remove the
organic solvent; (e) packaging the electrical lead resulting from
(d); and (f) sterilizing the packaged electrical lead resulting
from (e); and wherein the anti-inflammatory is selected from the
group consisting of medrysone, desoximetasone, triamcinolone,
fluoromethalone, flurandrenolide, halcinonide, betamethasone
benzoate, triamicinolone acetonide, diflorasone diacetate,
betamethasone valerate, dexamethasone, and beclomethasone
dipropionate anhydrous.
[1060] In certain embodiments, the combining comprises: (a)
assembling or providing an electrical lead having an electrode; (b)
mixing an anti-scarring agent and an anti-inflammatory agent with
an organic solvent to form a solution; (c) applying the solution to
the electrode; (d) drying the solution on the electrical lead to
remove the organic solvent; (e) packaging the electrical lead
resulting from (d); and (f) sterilizing the packaged electrical
lead resulting from (e); and wherein the anti-inflammatory is
selected from the group consisting of medrysone, desoximetasone,
triamcinolone, fluoromethalone, flurandrenolide, halcinonide,
betamethasone benzoate, triamicinolone acetonide, diflorasone
diacetate, betamethasone valerate, dexamethasone, and
beclomethasone dipropionate anhydrous.
[1061] In certain embodiments, the combining comprises: (a)
assembling or providing an electrical lead having a porous
electrode tip; (b) mixing an anti-scarring agent and an
anti-inflammatory agent with an organic solvent to form a solution;
(c) applying the solution to the porous electrode tip; (d) drying
the solution on the electrical lead to remove the organic solvent;
(e) packaging the electrical lead resulting from (d); and (f)
sterilizing the packaged electrical lead resulting from (e); and
wherein the anti-inflammatory is selected from the group consisting
of medrysone, desoximetasone, triamcinolone, fluoromethalone,
flurandrenolide, halcinonide, betamethasone benzoate,
triamicinolone acetonide, diflorasone diacetate, betamethasone
valerate, dexamethasone, and beclomethasone dipropionate
anhydrous.
[1062] Additional Features Related to Methods for Inhibiting
Scarring
[1063] The methods for making medical devices as described above
may also be further defined by one, two, or more of the following
features: the agent inhibits cell regeneration; the agent inhibits
angiogenesis; the agent inhibits fibroblast migration; the agent
inhibits fibroblast proliferation; the agent inhibits deposition of
extracellular matrix; the agent inhibits tissue remodeling; the
agent is an angiogenesis inhibitor; the agent is a 5-lipoxygenase
inhibitor or antagonist; the agent is a chemokine receptor
antagonist; the agent is a cell cycle inhibitor; the agent is a
taxane; the agent is an anti-microtubule agent; the agent is
paclitaxel; the agent is not paclitaxel; the agent is an analogue
or derivative of paclitaxel; the agent is a vinca alkaloid; the
agent is camptothecin or an analogue or derivative thereof; the
agent is a podophyllotoxin; the agent is a podophyllotoxin, wherein
the podophyllotoxin is etoposide or an analogue or derivative
thereof; the agent is an anthracycline; the agent is an
anthracycline, wherein the anthracycline is doxorubicin or an
analogue or derivative thereof; the agent is an anthracycline,
wherein the anthracycline is mitoxantrone or an analogue or
derivative thereof; the agent is a platinum compound; the agent is
a nitrosourea; the agent is a nitroimidazole; the agent is a folic
acid antagonist; the agent is a cytidine analogue; the agent is a
pyrimidine analogue; the agent is a fluoropyrimidine analogue; the
agent is a purine analogue; the agent is a nitrogen mustard or an
analogue or derivative thereof; the agent is a hydroxyurea; the
agent is a mytomicin or an analogue or derivative thereof; the
agent is an alkyl sulfonate; the agent is a benzamide or an
analogue or derivative thereof; the agent is a nicotinamide or an
analogue or derivative thereof; the agent is a halogenated sugar or
an analogue or derivative thereof; the agent is a DNA alkylating
agent; the agent is an anti-microtubule agent; the agent is a
topoisomerase inhibitor; the agent is a DNA cleaving agent; the
agent is an antimetabolite; the agent inhibits adenosine deaminase;
the agent inhibits purine ring synthesis; the agent is a nucleotide
interconversion inhibitor; the agent inhibits dihydrofolate
reduction; the agent blocks thymidine monophosphate; the agent
causes DNA damage; the agent is a DNA intercalation agent; the
agent is a RNA synthesis inhibitor; the agent is a pyrimidine
synthesis inhibitor; the agent inhibits ribonucleotide synthesis or
function; the agent inhibits thymidine monophosphate synthesis or
function; the agent inhibits DNA synthesis; the agent causes DNA
adduct formation; the agent inhibits protein synthesis; the agent
inhibits microtubule function; the agent is a cyclin dependent
protein kinase inhibitor; the agent is an epidermal growth factor
kinase inhibitor; the agent is an elastase inhibitor; the agent is
a factor Xa inhibitor; the agent is a farnesyltransferase
inhibitor; the agent is a fibrinogen antagonist; the agent is a
guanylate cyclase stimulant; the agent is a heat shock protein 90
antagonist; the agent is a heat shock protein 90 antagonist,
wherein the heat shock protein 90 antagonist is geldanamycin or an
analogue or derivative thereof; the agent is a guanylate cyclase
stimulant; the agent is a HMGCoA reductase inhibitor; the agent is
a HMGCoA reductase inhibitor, wherein the HMGCoA reductase
inhibitor is simvastatin or an analogue or derivative thereof; the
agent is a hydroorotate dehydrogenase inhibitor; the agent is an
IKK2 inhibitor; the agent is an IL-1 antagonist; the agent is an
ICE antagonist; the agent is an IRAK antagonist; the agent is an
IL-4 agonist; the agent is an immunomodulatory agent; the agent is
sirolimus or an analogue or derivative thereof; the agent is not
sirolimus; the agent is everolimus or an analogue or derivative
thereof; the agent is tacrolimus or an analogue or derivative
thereof; the agent is not tacrolimus; the agent is biolmus or an
analogue or derivative thereof; the agent is tresperimus or an
analogue or derivative thereof; the agent is auranofin or an
analogue or derivative thereof; the agent is 27-0-demethylrapamycin
or an analogue or derivative thereof; the agent is gusperimus or an
analogue or derivative thereof; the agent is pimecrolimus or an
analogue or derivative thereof; the agent is ABT-578 or an analogue
or derivative thereof; the agent is an inosine monophosphate
dehydrogenase (IMPDH) inhibitor; the agent is an IMPDH inhibitor,
wherein the IMPDH inhibitor is mycophenolic acid or an analogue or
derivative thereof; the agent is an IMPDH inhibitor, wherein the
IMPDH inhibitor is 1-alpha-25 dihydroxy vitamin D.sub.3 or an
analogue or derivative thereof; the agent is a leukotriene
inhibitor; the agent is a MCP-1 antagonist; the agent is a MMP
inhibitor; the agent is an NF kappa B inhibitor; the agent is an NF
kappa B inhibitor, wherein the NF kappa B inhibitor is Bay 11-7082;
the agent is an NO antagonist; the agent is a p38 MAP kinase
inhibitor; the agent is a p38 MAP kinase inhibitor, wherein the p38
MAP kinase inhibitor is SB 202190; the agent is a phosphodiesterase
inhibitor; the agent is a TGF beta inhibitor; the agent is a
thromboxane A2 antagonist; the agent is a TNF alpha antagonist; the
agent is a TACE inhibitor; the agent is a tyrosine kinase
inhibitor; the agent is a vitronectin inhibitor; the agent is a
fibroblast growth factor inhibitor; the agent is a protein kinase
inhibitor; the agent is a PDGF receptor kinase inhibitor; the agent
is an endothelial growth factor receptor kinase inhibitor; the
agent is a retinoic acid receptor antagonist; the agent is a
platelet derived growth factor receptor kinase inhibitor; the agent
is a fibrinogen antagonist; the agent is an antimycotic agent; the
agent is an antimycotic agent, wherein the antimycotic agent is
sulconizole; the agent is a bisphosphonate; the agent is a
phospholipase A1 inhibitor; the agent is a histamine H1/H2/H3
receptor antagonist; the agent is a macrolide antibiotic; the agent
is a GPIIb/IIIa receptor antagonist; the agent is an endothelin
receptor antagonist; the agent is a peroxisome
proliferator-activated receptor agonist; the agent is an estrogen
receptor agent; the agent is a somastostatin analogue; the agent is
a neurokinin 1 antagonist; the agent is a neurokinin 3 antagonist;
the agent is a VLA-4 antagonist; the agent is an osteoclast
inhibitor; the agent is a DNA topoisomerase ATP hydrolyzing
inhibitor; the agent is an angiotensin I converting enzyme
inhibitor; the agent is an angiotensin II antagonist; the agent is
an enkephalinase inhibitor; the agent is a peroxisome
proliferator-activated receptor gamma agonist insulin sensitizer;
the agent is a protein kinase C inhibitor; the agent is a ROCK
(rho-associated kinase) inhibitor; the agent is a CXCR3 inhibitor;
the agent is an Itk inhibitor; the agent is a cytosolic
phospholipase A.sub.2-alpha inhibitor; the agent is a PPAR agonist;
the agent is an immunosuppressant; the agent is an Erb inhibitor;
the agent is an apoptosis agonist; the agent is a lipocortin
agonist; the agent is a VCAM-1 antagonist; the agent is a collagen
antagonist; the agent is an alpha 2 integrin antagonist; the agent
is a TNF alpha inhibitor; the agent is a nitric oxide inhibitor,
the agent is a cathepsin inhibitor; the agent is not an
anti-inflammatory agent; the agent is not a steroid; the agent is
not a glucocorticosteroid; the agent is not dexamethasone; the
agent is not beclomethasone; the agent is not dipropionate; the
agent is not an anti-infective agent; the agent is not an
antibiotic; the agent is not an anti-fungal agent; the composition
comprises a polymer; the composition comprises a polymeric carrier;
the anti-scarring agent inhibits adhesion between the medical
device and a host into which the medical device is implanted; the
medical device delivers the anti-scarring agent locally to tissue
proximate to the medical device; the medical device has a coating
that comprises the anti-scarring agent; the medical device has a
coating that comprises the agent and is disposed on a surface of
the electrical device; the medical device has a coating that
comprises the agent and directly contacts the electrical device;
the medical device has a coating that comprises the agent and
indirectly contacts the electrical device; the medical device has a
coating that comprises the agent and partially covers the
electrical device; the medical device has a coating that comprises
the agent and completely covers the electrical device; the medical
device has a uniform coating; the medical device has a non-uniform
coating; the medical device has a discontinuous coating; the
medical device has a patterned coating; the medical device has a
coating with a thickness of 100 .mu.m or less; the medical device
has a coating with a thickness of 10 .mu.m or less; the medical
device has a coating, and the coating adheres to the surface of the
electrical device upon deployment of the electrical device; the
medical device has a coating, and wherein the coating is stable at
room temperature for a period of 1 year; the medical device has a
coating, and wherein the anti-scarring agent is present in the
coating in an amount ranging between about 0.0001% to about 1% by
weight; the medical device has a coating, and wherein the
anti-scarring agent is present in the coating in an amount ranging
between about 1% to about 10% by weight; the medical device has a
coating, and wherein the anti-scarring agent is present in the
coating in an amount ranging between about 10% to about 25% by
weight; the medical device has a coating, and wherein the
anti-scarring agent is present in the coating in an amount ranging
between about 25% to about 70% by weight; the medical device has a
coating, and wherein the coating further comprises a polymer; the
medical device has a first coating having a first composition and a
second coating having a second composition; the medical device has
a first coating having a first composition and a second coating
having a second composition, wherein the first composition and the
second composition are different; the composition comprises a
polymer; the composition comprises a polymeric carrier; the
composition comprises a polymeric carrier, and wherein the
polymeric carrier comprises a copolymer; the composition comprises
a polymeric carrier, and wherein the polymeric carrier comprises a
block copolymer; the composition comprises a polymeric carrier, and
wherein the polymeric carrier comprises a random copolymer; the
composition comprises a polymeric carrier, and wherein the
polymeric carrier comprises a biodegradable polymer; the
composition comprises a polymeric carrier, and wherein the
polymeric carrier comprises a non-biodegradable polymer; the
composition comprises a polymeric carrier, and wherein the
polymeric carrier comprises a hydrophilic polymer; the composition
comprises a polymeric carrier, and wherein the polymeric carrier
comprises a hydrophobic polymer; the composition comprises a
polymeric carrier, and wherein the polymeric carrier comprises a
polymer having hydrophilic domains; the composition comprises a
polymeric carrier, and wherein the polymeric carrier comprises a
polymer having hydrophobic domains; the composition comprises a
polymeric carrier, and wherein the polymeric carrier comprises a
non-conductive polymer; the composition comprises a polymeric
carrier, and wherein the polymeric carrier comprises an elastomer;
the composition comprises a polymeric carrier, and wherein the
polymeric carrier comprises a hydrogel; the composition comprises a
polymeric carrier, and wherein the polymeric carrier comprises a
silicone polymer; the composition comprises a polymeric carrier,
and wherein the polymeric carrier comprises a hydrocarbon polymer;
the composition comprises a polymeric carrier, and wherein the
polymeric carrier comprises a styrene-derived polymer; the
composition comprises a polymeric carrier, and wherein the
polymeric carrier comprises a butadiene polymer; the composition
comprises a polymeric carrier, and wherein the polymeric carrier
comprises a macromer; the composition comprises a polymeric
carrier, and wherein the polymeric carrier comprises a
poly(ethylene glycol) polymer; the composition comprises a
polymeric carrier, and wherein the polymeric carrier comprises an
amorphous polymer; the medical device comprises a lubricious
coating; the anti-scarring agent is located within pores or holes
of the medical device; the anti-scarring agent is located within a
channel, lumen, or divet of the medical device; the medical device
further comprises a second pharmaceutically active agent; the
medical device further comprises an anti-inflammatory agent; the
medical device further comprises an agent that inhibits infection;
the medical device further comprises an agent that inhibits
infection, and wherein the agent is an anthracycline; the medical
device further comprises an agent that inhibits infection, and
wherein the agent is doxorubicin; the medical device further
comprises an agent that inhibits infection, and wherein the agent
is mitoxantrone; the medical device further comprises an agent that
inhibits infection, and wherein the agent is a fluoropyrimidine;
the medical device further comprises an agent that inhibits
infection, and wherein the agent is 5-fluorouracil (5-FU); the
medical device further comprises an agent that inhibits infection,
and wherein the agent is a folic acid antagonist; the medical
device further comprises an agent that inhibits infection, and
wherein the agent is methotrexate; the medical device further
comprises an agent that inhibits infection, and wherein the agent
is a podophylotoxin; the medical device further comprises an agent
that inhibits infection, and wherein the agent is etoposide; the
medical device further comprises an agent that inhibits infection,
and wherein the agent is a camptothecin; the medical device further
comprises an agent that inhibits infection, and wherein the agent
is a hydroxyurea; the medical device further comprises an agent
that inhibits infection, and wherein the agent is a platinum
complex; the medical device further comprises an agent that
inhibits infection, and wherein the agent is cisplatin; the medical
device further comprises an anti-thrombotic agent; the medical
device further comprises a visualization agent; the medical device
further comprises a visualization agent, wherein the visualization
agent is a radiopaque material, and wherein the radiopaque material
further comprises a metal, a halogenated compound, or a barium
containing compound; the medical device further comprises a
visualization agent, wherein the visualization agent is a
radiopaque material, and wherein the radiopaque material further
comprises barium, tantalum, or technetium; the medical device
further comprises a visualization agent, and wherein the
visualization agent is a MRI responsive material; the medical
device further comprises a visualization agent, and wherein the
visualization agent further comprises a gadolinium chelate; the
medical device further comprises a visualization agent, and wherein
the visualization agent further comprises iron, magnesium,
manganese, copper, or chromium; the medical device further
comprises a visualization agent, and wherein the visualization
agent further comprises an iron oxide compound; the medical device
further comprises a visualization agent, and wherein the
visualization agent further comprises a dye, pigment, or colorant;
the medical device further comprises an echogenic material; the
medical device further comprises an echogenic material, and wherein
the echogenic material is in the form of a coating; the medical
device is sterile; the anti-scarring agent is released into tissue
in the vicinity of the medical device after deployment of the
medical device; the anti-scarring agent is released into tissue in
the vicinity of the medical device after deployment of the medical
device, and wherein the tissue is connective tissue; the
anti-scarring agent is released into tissue in the vicinity of the
medical device after deployment of the medical device, and wherein
the tissue is muscle tissue; the anti-scarring agent is released
into tissue in the vicinity of the medical device after deployment
of the medical device, and wherein the tissue is nerve tissue; the
anti-scarring agent is released into tissue in the vicinity of the
medical device after deployment of the medical device, and wherein
the tissue is epithelium tissue; the anti-scarring agent is
released in effective concentrations from the medical device over a
period ranging from the time of deployment of the medical device to
about 1 year; the anti-scarring agent is released in effective
concentrations from the medical device over a period ranging from
about 1 month to 6 months; the anti-scarring agent is released in
effective concentrations from the medical device over a period
ranging from about 1-90 days; the anti-scarring agent is released
in effective concentrations from the medical device at a constant
rate; the anti-scarring agent is released in effective
concentrations from the medical device at an increasing rate; the
anti-scarring agent is released in effective concentrations from
the medical device at a decreasing rate; the anti-scarring agent is
released in effective concentrations from the composition
comprising the anti-scarring agent by diffusion over a period
ranging from the time of deployment of the medical device to about
90 days; the anti-scarring agent is released in effective
concentrations
from the composition comprising the anti-scarring agent by erosion
of the composition over a period ranging from the time of
deployment of the medical device to about 90 days; the medical
device comprises about 0.01 .mu.g to about 10 .mu.g of the
anti-scarring agent; the medical device comprises about 10 .mu.g to
about 10 mg of the anti-scarring agent; the medical device
comprises about 10 mg to about 250 mg of the anti-scarring agent;
the medical device comprises about 250 mg to about 1000 mg of the
anti-scarring agent; the medical device comprises about 1000 mg to
about 2500 mg of the anti-scarring agent; a surface of the medical
device comprises less than 0.01 .mu.g of the anti-scarring agent
per mm.sup.2 of medical device surface to which the anti-scarring
agent is applied; a surface of the medical device comprises about
0.01 .mu.g to about 1 .mu.g of the anti-scarring agent per mm.sup.2
of medical device surface to which the anti-scarring agent is
applied; a surface of the medical device comprises about 1 .mu.g to
about 10 .mu.g of the anti-scarring agent per mm.sup.2 of medical
device surface to which the anti-scarring agent is applied; a
surface of the medical device comprises about 10 .mu.g to about 250
.mu.g of the anti-scarring agent per mm.sup.2 of medical device
surface to which the anti-scarring agent is applied; a surface of
the medical device comprises about 250 .mu.g to about 1000 .mu.g of
the anti-scarring agent of anti-scarring agent per mm.sup.2 of
medical device surface to which the anti-scarring agent is applied;
a surface of the medical device comprises about 1000 .mu.g to about
2500 .mu.g of the anti-scarring agent per mm.sup.2 of medical
device surface to which the anti-scarring agent is applied; the
combining is performed by direct affixing the agent or the
composition to the electrical device; the combining is performed by
spraying the agent or the component onto the electrical device; the
combining is performed by electrospraying the agent or the
composition onto the electrical device; the combining is performed
by dipping the electrical device into a solution comprising the
agent or the composition; the combining is performed by covalently
attaching the agent or the composition to the electrical device;
the combining is performed by non-covalently attaching the agent or
the composition to the electrical device; the combining is
performed by coating the electrical device with a substance that
contains the agent or the composition; the combining is performed
by coating the electrical device with a substance that absorbs the
agent; the combining is performed by interweaving the electrical
device with a thread composed of, or coated with, the agent or the
composition; the combining is performed by completely covering the
electrical device with a sleeve that contains the agent or the
composition; the combining is performed by covering a portion of
the electrical device with a sleeve that contains the agent or the
composition; the combining is performed by completely covering the
electrical device with a cover that contains the agent or the
composition; the combining is performed by covering a portion of
the electrical device with a cover that contains the agent or the
composition; the combining is performed by completely covering the
electrical device with an electrospun fabric that contains the
agent or the composition; the combining is performed by covering a
portion of the electrical device with an electrospun fabric that
contains the agent or the composition; the combining is performed
by completely covering the electrical device with a mesh that
contains the agent or the composition; the combining is performed
by covering a portion of the electrical device with a mesh that
contains the agent or the composition; the combining is performed
by constructing a portion of the electrical device with the agent
or the composition; the combining is performed by impregnating the
electrical device with the agent or the composition; the combining
is performed by constructing a portion of the electrical device
from a degradable polymer that releases the agent; the combining is
performed by dipping the electrical device into a solution that
comprise the agent and an inert solvent for the electrical device;
the combining is performed by dipping the electrical device into a
solution that comprises the agent and a solvent that will swill the
electrical device; the combining is performed by dipping the
electrical device into a solution that comprises the agent and a
solvent that will dissolve the electrical device; the combining is
performed by dipping the electrical device into a solution that
comprises the agent, a polymer and an inert solvent for the
electrical device; the combining is performed by dipping the
electrical device into a solution that comprises the agent, a
polymer and a solvent that will swill the electrical device; the
combining is performed by dipping the electrical device into a
solution that comprises the agent, a polymer and a solvent that
will dissolve the electrical device; the combining is performed by
spraying the electrical device into a solution that comprises the
agent and an inert solvent for the electrical device; the combining
is performed by spraying the electrical device into a solution that
comprises the agent and a solvent that will swill the electrical
device; the combining is performed by spraying the electrical
device into a solution that comprises the agent and a solvent that
will dissolve the electrical device; the combining is performed by
spraying the electrical device into a solution that comprises the
agent, a polymer and an inert solvent for the electrical device;
the combining is performed by spraying the electrical device into a
solution that comprises the agent, a polymer and a solvent that
will swill the electrical device; and the combining is performed by
spraying the electrical device into a solution that comprises the
agent, a polymer and a solvent that will dissolve the electrical
device.
[1064] The following examples are offered by way of illustration,
and not by way of limitation.
EXAMPLES
Example 1
Parylene Coating
[1065] A metallic portion of an electrical device (e.g., a
neurostimulator or an electrical lead) is washed by dipping it into
HPLC grade isopropanol. A parylene primer layer (about 1 to 10 um)
is deposited onto the cleaned electrical device using a parylene
coater (e.g., PDS 2010 LABCOATER 2 from Cookson Electronics) and
di-p-xylylene (PARYLENE N) or dichloro-di-p-xylylene (PARYLENE D)
(both available from Specialty Coating Systems, Indianapolis, Ind.)
as the coating feed material.
Example 2
Paclitaxel Coating--Partial Coating
[1066] Paclitaxel solutions are prepared by dissolving paclitaxel
(5 mg, 10 mg, 50 mg, 100 mg, 200 mg and 500 mg) in 5 ml HPLC grade
THF. A coated portion of a parylene-coated device (as prepared in,
e.g., Example 1) is dipped into a paclitaxel/THF solution. After a
selected incubation time, the device is removed from the solution
and dried in a forced air oven (50.degree. C). The device then is
further dried in a vacuum oven overnight. The amount of paclitaxel
used in each solution and the incubation time is varied such that
the amount of paclitaxel coated onto the device is in the range of
0.06 .mu.g/mm.sup.2 to 10 .mu.g/mm.sup.2 (.mu.g paclitaxel/mm.sup.2
of the device which is coated with paclitaxel after being placed in
the THF/paclitaxel solution). The time during which the device is
maintained in the paclitaxel/THF solution may be varied, where
longer soak times generally provide for more paclitaxel to be
adsorbed onto the device. In additional examples, one of the
following exemplary compounds may be used in lieu of paclitaxel:
mitoxantrone, doxorubicin, epithilone B, etoposide, TAXOTERE,
tubercidin, vinblastine, geldanamycin, simvastatin, sirolimus,
everolimus, halifuginone, mycophenolic acid, 1-alpha-25 dihydroxy
vitamin D.sub.3, Bay 11-7082, SB202190, mithramycin, pimecrolimus
and sulconizole.
Example 3
Paclitaxel Coating--Complete Coating
[1067] Paclitaxel solutions are prepared by dissolving paclitaxel
(5 mg, 10 mg, 50 mg, 100 mg, 200 mg and 500 mg) in 5 ml HPLC grade
THF. An entire parylene coated device (coated as in, e.g., Example
1) is then dipped into the paclitaxel/THF solution. After a
selected incubation time, the device is removed and dried in a
forced air oven (50.degree. C.). The device is then further dried
in a vacuum oven overnight. The amount of paclitaxel used in each
solution and the incubation time is varied such that the amount of
paclitaxel coated onto the device is in the range of 0.06
.mu.g/mm.sup.2 to 10 .mu.g/mm.sup.2. In additional examples, one of
the following exemplary compounds may be used in lieu of
paclitaxel: mitoxantrone, doxorubicin, epithilone B, etoposide,
TAXOTERE, tubercidin, halifuginone, vinblastine, geldanamycin,
simvastatin, sirolimus, everolimus, pimecrolimus, mycophenolic
acid, 1-alpha-25 dihydroxy vitamin D.sub.3, Bay 11-7082, SB202190,
mithramycin and sulconizole.
Example 4
Application of a Parylene Overcoat
[1068] A paclitaxel coated device (prepared as in, e.g., Example 2
or 3) is placed in a parylene coater and an additional thin layer
of parylene is deposited on the paclitaxel coated device using the
procedure described in Example 1. The coating duration is selected
to provide a parylene top-coat thickness that will cause the device
to have a desired elution profile for the paclitaxel.
Example 5
Application of an Echogenic Coating Layer
[1069] DESMODUR (an isocyanate pre-polymer Bayer AG) (25% w/v) is
dissolved in a 50:50 mixture of dimethylsulfoxide and
tetrahydrofuran. A paclitaxel/parylene overcoated device (prepared
as in, e.g., Example 4) is then dipped into the pre-polymer
solution. The device is removed from the solution after a selected
incubation time, and the coating is then partially dried at room
temperature for 3 to 5 minutes. The device is then immersed in a
beaker of water (room temperature) for 3-5 minutes to cause the
polymerization reaction to occur rapidly. An echogenic coating is
formed.
Example 6
Paclitaxel/Polymer Coating--Partial Coating
[1070] Several 5% solutions of poly(ethylene-co-vinyl acetate)
{EVA} (60% vinyl acetate) are prepared using THF as the solvent.
Selected amounts of paclitaxel (0.01%, 0.05%, 0.1%, 0.5%, 1%, 5%,
10%, 20%, 30% (w/w drug to polymer) are added to the EVA solutions.
An electrical device or a portion thereof is dipped into a
paclitaxel/EVA solution. After removing the device from the
solution, the coating is dried by placing the device in a forced
air oven (40.degree. C.) for 3 hours. The coated device is then
further dried under vacuum for 24 hours. This dip coating process
may be repeated to increase the amount of polymer/paclitaxel coated
onto the device. In addition, higher paclitaxel concentrations in
the polymer/THF/paclitaxel solution and/or a longer soak time may
be used to increase the amount of polymer/paclitaxel that is coated
onto the device. In additional examples, one of the following
exemplary compounds may be used in lieu of paclitaxel:
mitoxantrone, mithramycin, doxorubicin, epithilone B, etoposide,
TAXOTERE, tubercidin, vinblastine, geldanamycin, Simvastatin,
halifuginone, sirolimus, everolimus, pimecrolimus, mycophenolic
acid, 1-alpha-25 dihydroxy vitamin D3, Bay 11-7082, SB202190, and
sulconizole.
Example 7
Paclitaxel-Heparin Coating
[1071] Several 5% solutions of poly(ethylene-co-vinyl acetate)
{EVA} (60% vinyl acetate) are prepared using THF as the solvent.
Selected amounts (0.01%, 0.05%, 0.1%, 0.5%, 1%, 5%, 10%, 20%, 30%
(w/w drug to polymer) of paclitaxel and a solution of tridodecyl
methyl ammonium chloride-heparin complex (PolySciences) are added
to each of the EVA solutions. All or a portion of an electrical
device is dipped into the paclitaxel/EVA solution. After removing
the device from the solution, the coating is dried by placing the
device in a forced air oven (40.degree. C.) for 3 hours. The coated
device is then further dried under vacuum for 24 hours. The dip
coating process may be repeated to increase the amount of
polymer/heparin complex coated onto the device. In additional
examples, one of the following exemplary compounds may be used in
lieu of paclitaxel: mitoxantrone, mithramycin, doxorubicin,
epithilone B, etoposide, TAXOTERE, tubercidin, halifuginone,
vinblastine, geldanamycin, simvastatin, sirolimus, everolimus,
pimecrolimus, mycophenolic acid, 1-alpha-25 dihydroxy vitamin
D.sub.3, Bay 11-7082, SB202190, and sulconizole.
Example 8
Paclitaxel--Heparin/Heparin Coating
[1072] An uncoated portion of a paclitaxel-heparin coated device
(prepared as in, e.g., Example 7) is dipped into a 5% EVA/THF
solution containing a selected amount of a tridodecyl methyl
ammonium chloride-heparin complex solution (PolySciences) (0.1%,
0.5%, 1%, 2.5%, 5%, 10% (v/v)). After removing the device from the
solution, the coating is dried by placing the device in a forced
air oven (40.degree. C.) for 3 hours. The coated device is then
further dried under vacuum for 24 hours. This provides a device
with a paclitaxel/heparin coating on one or more portions of the
device and a heparin coating on one or more other parts of the
device. In additional examples, one of the following exemplary
compounds may be used in lieu of paclitaxel: mitoxantrone,
mithramycin, doxorubicin, epithilone B, etoposide, TAXOTERE,
tubercidin, vinblastine, geldanamycin, halifuginone, simvastatin,
sirolimus, everolimus, pimecrolimus, mycophenolic acid, 1-alpha-25
dihydroxy vitamin D.sub.3, Bay 11-7082, SB202190, and
sulconizole.
Example 9
Paclitaxel/Polymer Coating--Partial Coating
[1073] Several 5% solutions of poly(styrene-co-isobutylene-styrene)
(SIBS) are prepared using THF as the solvent. A selected amount of
paclitaxel is added to each SIBS solution. One or more portions of
a device are dipped into the paclitaxel/SIBS solution. After
removing the device from the solution, the coating is dried by
placing the device in a forced air oven (40.degree. C.) for 3
hours. The coated device is then further dried under vacuum for 24
hours. The dip coating process may be repeated to increase the
amount of polymer/paclitaxel coated onto the device. In addition,
higher paclitaxel concentrations in the polymer/THF/paclitaxel
solution and/or a longer soak time may be used to increase the
amount of polymer/paclitaxel that is coated onto the device. In
additional examples, one of the following exemplary compounds may
be used in lieu of paclitaxel: mitoxantrone, doxorubicin,
epithilone B, etoposide, TAXOTERE, tubercidin, vinblastine,
geldanamycin, simvastatin, mithramycin, pimecrolimus, sirolimus,
everolimus, mycophenolic acid, 1-alpha-25 dihydroxy vitamin
D.sub.3, Bay 11-7082, SB202190, and sulconizole.
Example 10
Paclitaxel/Polymer Coating--Echogenic Overcoat
[1074] A paclitaxel-coated electrical device prepared as in Example
9 is dipped into a DESMODUR solution (50% w/v) (50:50 mixture of
dimethylsulfoxide and tetrahydrofuran). The device is then removed
and the coating is partially dried at room temperature for 3 to 5
minutes. The device is then immersed in a beaker of water (room
temperature) for 3-5 minutes to cause the polymerization reaction
to occur rapidly. An echogenic coating is thereby formed. In
additional examples, one of the following exemplary compounds may
be used in lieu of paclitaxel: mitoxantrone, doxorubicin,
epithilone B, mithramycin, etoposide, TAXOTERE, tubercidin,
vinblastine, geldanamycin, simvastatin, sirolimus, everolimus,
pimecrolimus, mycophenolic acid, 1-alpha-25 dihydroxy vitamin
D.sub.3, Bay 11-7082, SB202190, and sulconizole.
Example 11
Polymer/Echogenic Coating
[1075] A 5% solution of poly(styrene-co-isobutylene-styrene) (SIBS)
is prepared using THF as the solvent. An electrical device is
dipped into the SIBS solution. After a selected incubation time,
the device is removed from the solution, and the coating is dried
by placing the device in a forced air oven (40.degree. C.) for 3
hours. The coated device is then further dried under vacuum for 24
hours.
[1076] A coated device is dipped into a DESMODUR solution (50:50
mixture of dimethylsulfoxide and tetrahydrofuran). The device is
then removed and the coating is then partially dried at room
temperature for 3 to 5 minutes. The device is then immersed in a
beaker of water (room temperature) for 3-5 minutes to cause the
polymerization reaction to occur rapidly. The device is dried under
vacuum for 24 hours at room temperature. All or a portion of the
coated device is immersed into a solution of paclitaxel (5% w/v in
methanol). The device is removed and dried at 40.degree. C. for 1
hour and then under vacuum for 24 hours.
[1077] The amount of paclitaxel absorbed by the polymeric coating
can be altered by changing the paclitaxel concentration, the
immersion time as well as the solvent composition of the paclitaxel
solution. In additional examples, one of the following exemplary
compounds may be used in lieu of paclitaxel: mitoxantrone,
mithramycin, doxorubicin, epithilone B, etoposide, TAXOTERE,
tubercidin, vinblastine, geldanamycin, halifuginone, simvastatin,
sirolimus, everolimus, pimecrolimus, mycophenolic acid, 1-alpha-25
dihydroxy vitamin D.sub.3, Bay 11-7082, SB202190, and
sulconizole.
Example 12
Paclitaxel/Siloxane Coating--Partial Coating
[1078] An electrical device is coated with a silioxane layer by
exposing the device to gaseous tetramethylcyclotetrasiloxane that
is then polymerized by low energy plasma polymerization onto the
device surface. The thickness of the siloxane layer can be
increased by increasing the polymerization time. After
polymerization, a portion of the coated device is then immersed
into a paclitaxel/THF solution (5% w/v) for a selected period of
time to allow the paclitaxel to absorb into the siloxane coating.
The device is then removed from the solution and is dried for 2
hours at 40.degree. C. in a forced air oven. The device is then
further dried under vacuum at room temperature for 24 hours. The
amount of paclitaxel coated onto the device can be varied by
altering the concentration of the paclitaxel/THF solution and by
altering the immersion time of the device in the paclitaxel THF
solution. In additional examples, one of the following exemplary
compounds may be used in lieu of paclitaxel: mitoxantrone,
mithramycin, doxorubicin, epithilone B, etoposide, TAXOTERE,
tubercidin, vinblastine, geldanamycin, halifuginone, simvastatin,
sirolimus, everolimus, pimecrolimus, mycophenolic acid, 1-alpha-25
dihydroxy vitamin D.sub.3, Bay 11-7082, SB202190, and
sulconizole.
Example 13
Spray-Coated Devices
[1079] Several 2% solutions of poly(styrene-co-isobutylene-styrene)
(SIBS) (50 ml) are prepared using THF as the solvent. A selected
amount of paclitaxel (0.01%, 0.05%, 0.1%, 0.5%, 1%, 2.5%, 5%, 10%
and 20% (w/w with respect to the polymer)) is added to each
solution. An electrical device is held with a pair of tweezers and
is then spray coated with one of the paclitaxel/polymer solutions
using an airbrush. The device is then air-dried. The device is then
held in a new location using the tweezers and a second coat of a
paclitaxel/polymer solution having the same concentration is
applied to the device. The device is air-dried and is then dried
under vacuum at room temperature overnight. The total amount of
paclitaxel coated onto the device can be altered by changing the
paclitaxel content in the solution as well as by increasing the
number of coatings that are applied. In additional examples, one of
the following exemplary compounds may be used in lieu of
paclitaxel: mitoxantrone, mithramycin, doxorubicin, epithilone B,
etoposide, TAXOTERE, tubercidin, vinblastine, geldanamycin,
simvastatin, sirolimus, everolimus, pimecrolimus, mycophenolic
acid, 1-alpha-25 dihydroxy vitamin D.sub.3, Bay 11-7082, SB202190,
and sulconizole.
Example 14
Drug Coated Device-Non-Degradeable
[1080] An electrical device is attached to a rotating mandrel. A
solution of paclitaxel (5% w/w) in a polyurethane (CHRONOFLEX 85A;
CardioTech Biomaterials)/THF solution (2.5% w/v) is then sprayed
onto all or a portion of the outer surface of the device. The
solution is sprayed on at a rate that ensures that the device is
not damaged or saturated with the sprayed solution. The device is
allowed to air dry after which it is dried under vacuum for 24
hours. In additional examples, one of the following exemplary
compounds may be used in lieu of paclitaxel: mitoxantrone,
mithramycin, doxorubicin, epithilone B, etoposide, TAXOTERE,
tubercidin, vinblastine, geldanamycin, simvastatin, sirolimus,
everolimus, pimecrolimus, mycophenolic acid, 1-alpha-25 dihydroxy
vitamin D.sub.3, Bay 11-7082, SB202190, and sulconizole.
Example 15
Drug Coated Device--Degradeable
[1081] An electrical device is attached to a rotating mandrel. A
paclitaxel (5% w/w) in a PLGA/ethyl acetate solution (2.5% w/v) is
then sprayed onto all or portion of the outer surface of the
device. The solution is sprayed on at a rate that ensures that the
device is not damaged or saturated with the sprayed solution. The
device is allowed to air dry, after which it is dried under vacuum
at room temperature for 24 hours. In additional examples, one of
the following exemplary compounds may be used in lieu of
paclitaxel: mitoxantrone, doxorubicin, epithilone B, etoposide,
mithramycin, TAXOTERE, tubercidin, vinblastine, geldanamycin,
simvastatin, sirolimus, everolimus, pimecrolimus, mycophenolic
acid, 1-alpha-25 dihydroxy vitamin D.sub.3, Bay 11-7082, SB202190,
and sulconizole.
Example 16
Drug Coated Device--Degradeable Overcoat
[1082] A drug-coated electrical device prepared as in Example 14 or
Example 15 is attached to a rotating mandrel. A PLGA/ethyl acetate
solution (2.5% w/v) is then sprayed onto all or a portion of the
outer surface of the device, such that a coating is formed over the
first drug containing coating. The solution is sprayed on at a rate
that ensures that the device is not damaged or saturated with the
sprayed solution. The device is allowed to air dry after which it
is dried under vacuum at room temperature for 24 hours.
Example 17
Drug-Loaded Microsphere Formulation
[1083] Paclitaxel (10% w/w) is added to a solution of PLGA (50/50,
Mw 54,000) in DCM (5% w/v). The solution is vortexed and then
poured into a stirred (overhead stirrer with a 3 bladed TEFLON
coated stirrer) aqueous PVA solution (approx. 89% hydrolysed,
Mw.apprxeq.13,000, 2% w/v). The solution is stirred for 6 hours
after which the solution is centrifuged to sediment the
microspheres. The microspheres are resuspended in water. The
centrifugation--ishing process is repeated 4 times. The final
microsphere solution is flash frozen in an acetone/dry-ice bath.
The frozen solution is then freeze-dried to produce a fine powder.
The size of the microspheres formed can be altered by changing the
stirring speed and/or the PVA solution concentration. The freeze
dried powder can be resuspended in PBS or saline and can be used
for direct injection, as an incubation fluid or as an irrigation
fluid. In additional examples, one of the following exemplary
compounds may be used in lieu of paclitaxel: mitoxantrone,
doxorubicin, epithilone B, mithramycin, etoposide, TAXOTERE,
tubercidin, vinblastine, geldanamycin, simvastatin, sirolimus,
everolimus, pimecrolimus, mycophenolic acid, 1-alpha-25 dihydroxy
vitamin D.sub.3, Bay 11-7082, SB202190, and sulconizole.
Example 18
Drug Coated Device (Exterior Coating)
[1084] All or a portion of an electrical device is dipped into a
polyurethane (CHRONOFLEX 85A)/THF solution (2.5% w/v). The coated
device is allowed to air dry for 10 seconds. The device is then
rolled in powdered paclitaxel that has been spread thinly on a
piece of release liner to provide a device coated with between 0.1
to 10 mg of paclitaxel. The rolling process is done in such a
manner that the paclitaxel powder predominantly adheres to the
exterior side of the coated device. The device is air-dried for 1
hour followed by vacuum drying at room temperature for 24 hours. In
additional examples, one of the following exemplary compounds may
be used in lieu of paclitaxel: mitoxantrone, doxorubicin,
epithilone B, etoposide, TAXOTERE, tubercidin, vinblastine,
geldanamycin, simvastatin, mithramycin, sirolimus, everolimus,
pimecrolimus, mycophenolic acid, 1-alpha-25 dihydroxy vitamin
D.sub.3, Bay 11-7082, SB202190, and sulconizole.
Example 19
Drug Coated Device (Exterior Coating) with a Heparin Coating
[1085] A drug-coated device prepared as in Example 18 is further
coated with a heparin coating. A device prepared as in Example 18
is dipped into a solution of heparin-benzalkonium chloride complex
(1.5% (w/v) in isopropanol, STS Biopolymers). The device is removed
from the solution and air-dried for 1 hour followed by vacuum
drying for 24 hours. This process coats both the interior and
exterior surfaces of the device with heparin.
Example 20
Partial Drug Coating of a Device
[1086] An electrical device is attached to a rotating mandrel. A
mask system is set up so that only a portion of the device surface
is exposed. A solution of paclitaxel (5% w/w) in a polyurethane
(CHRONOFLEX 85A)/THF solution (2.5% w/v) is then sprayed onto the
exposed portion of the device. The solution is sprayed on at a rate
that ensures that the device is not damaged or saturated with the
sprayed solution. The device is allowed to air dry after which it
is dried under vacuum at room temperature for 24 hours. In
additional examples, one of the following exemplary compounds may
be used in lieu of paclitaxel: mitoxantrone, doxorubicin,
epithilone B, etoposide, TAXOTERE, tubercidin, vinblastine,
geldanamycin, mithramycin, simvastatin, sirolimus, everolimus,
pimecrolimus, mycophenolic acid, 1-alpha-25 dihydroxy vitamin
D.sub.3, Bay 11-7082, SB202190, and sulconizole.
Example 21
Drug--Dexamethasone Coated Device
[1087] An electrical device is coated as in Example 20. The mask is
then rearranged so that a previously masked portion of the device
is exposed. The exposed portion of the device is then sprayed with
a dexamethasone (10% w/w)/polyurethane (CHRONOFLEX 85A)/THF
solution (2.5% w/v). The device is air dried, after which it is
dried under vacuum at room temperature for 24 hours. In additional
examples, one of the following exemplary compounds may be used in
lieu of paclitaxel: mitoxantrone, doxorubicin, epithilone B,
etoposide, TAXOTERE, tubercidin, vinblastine, mithramycin,
geldanamycin, simvastatin, sirolimus, everolimus, pimecrolimus,
mycophenolic acid,1-alpha-25 dihydroxy vitamin D.sub.3, Bay
11-7082, SB202190, and sulconizole.
Example 22
Drug--Heparin Coated Device
[1088] An electrical device is coated as in Example 20. The mask is
then rearranged so that only a previously masked portion of the
device is exposed. The exposed surface of the device is then
sprayed with a heparin-benzalkonium chloride complex (1.5% (w/v) in
isopropanol (STS Biopolymers). The sample is air dried after which
it is dried under vacuum for 24 hours. In additional examples, one
of the following exemplary compounds may be used in lieu of
paclitaxel: mitoxantrone, doxorubicin, mithramycin, epithilone B,
etoposide, TAXOTERE, tubercidin, vinblastine, geldanamycin,
simvastatin, sirolimus, everolimus, pimecrolimus, mycophenolic
acid, 1-alpha-25 dihydroxy vitamin D.sub.3, Bay 11-7082, SB202190,
and sulconizole
Example 23
Drug-Dexamethaxone Coated Device
[1089] An electrical device is attached to a rotating mandrel. A
solution of paclitaxel (5% w/w) and dexamethazone (5% w/w) in a
PLGA (50/50, Mw.apprxeq.54,000)/ethyl acetate solution (2.5% w/v)
is sprayed onto all or a portion of the device. The solution is
sprayed on at a rate that ensures that the device is not damaged or
saturated with the sprayed solution. The device is allowed to air
dry after which it is dried under vacuum at room temperature for 24
hours. In additional examples, one of the following exemplary
compounds may be used in lieu of paclitaxel: mitoxantrone,
doxorubicin, mithramycin, epithilone B, etoposide, TAXOTERE,
tubercidin, vinblastine, geldanamycin, simvastatin, sirolimus,
everolimus, pimecrolimus, mycophenolic acid, 1-alpha-25 dihydroxy
vitamin D.sub.3, Bay 11-7082, SB202190, and sulconizole.
Example 24
Drug-Dexamethasone Coated Device (Sequential Coating)
[1090] An electrical device is attached to a rotating mandrel. A
solution of paclitaxel (5% w/w) in a PLGA (50/50,
Mw.apprxeq.54,000)/ethyl acetate solution (2.5% w/v) is sprayed
onto the outer surface of the device. The solution is sprayed on at
a rate that ensures that the device is not damaged or saturated
with the sprayed solution. The device is allowed to air dry. A
methanol solution of dexamethasone (2% w/v) is then sprayed onto
the outer surface of the device (at a rate that ensures that the
device is not damaged or saturated with the sprayed solution). The
device is allowed to air dry, after which it is dried under vacuum
at room temperature for 24 hours. In additional examples, one of
the following exemplary compounds may be used in lieu of
paclitaxel: mitoxantrone, doxorubicin, mithramycin, epithilone B,
etoposide, TAXOTERE, tubercidin, vinblastine, geldanamycin,
simvastatin, sirolimus, everolimus, pimecrolimus, mycophenolic
acid, 1-alpha-25 dihydroxy vitamin D.sub.3, Bay 11-7082, SB202190,
and sulconizole.
Example 25
Drug-Loading an Electrical Lead Comprising a Porous
Electrode--Paclitaxel
[1091] 10 ml solutions of paclitaxel are prepared by weighing in 1
mg, 5 mg, 10 mg, 20 mg, 50 mg, 75 mg, 100 mg, 200 mg, and 500 mg
paclitaxel into a 20 ml glass scintillation vial respectively and
then adding HPLC grade acetone. The solutions are gently shaken on
an orbital shaker for 1 hour at room temperature. An electrical
pacing lead that comprises a porous ball shaped electrode tip
(Medtronic, Inc.) is placed on a bench and a glass microscope slide
is placed under the tip portion of the lead. Using a 200 .mu.l
pipettor (Gilson) with the pipette tip touching the electode tip,
the 0.1 mg/ml paclitaxel solution is slowly applied to the porous
electrode tip until the electrode tip does not absorb any more
solution. The electrode is then allowed to air dry for 6 hours. The
process is repeated for all the prepared paclitaxel solutions on a
fresh electrode.
Example 26
Drug-Loading an Electrical Lead Comprising a Porous
Electrode--Paclitaxel/Beclomethasone
[1092] Several saturated 10 ml acetone solutions of beclomethasone
diproprionate anhydrous are prepared by adding the beclomethasone
diproprionate anhydrous to 10 ml acetone in 20 ml glass
scintillation vials until no more beclomethasone diproprionate
anhydrous will dissolve and solid beclomethasone diproprionate
anhydrous remains at the bottom of the vial. To each of these
saturated solutions, 1 mg, 5 mg, 10 mg, 20 mg, 50 mg, 75 mg, 100
mg, 200 mg, and 500 mg paclitaxel are added respectively. The
solutions are gently shaken on an orbital shaker for 1 hour at room
temperature. An electrical pacing lead that comprises a porous ball
shaped electrode tip (Medtronic, Inc.) is placed on a bench and a
glass microscope slide is placed under the tip portion of the lead.
Using a 200 uL Gilson pipettor with the pipette tip touching the
electode tip, the 0.1 mg/ml paclitaxel solution is slowly applied
to the porous electrode tip until the electrode tip will not absorb
any more solution. The electrode is then allowed to air dry for 6
hour. The process is repeated for all the prepared paclitaxel
solutions using a fresh electrode for each solution.
Example 27
Drug-Loading an Electrical Lead Comprising a Porous
Electrode--Paclitaxel/Polymer
[1093] 10 ml solutions of paclitaxel are prepared by weighing in 1
mg, 5 mg, 10 mg, 20 mg, 50 mg, 75 mg, 100 mg 200 mg and 500 mg
paclitaxel into a 20 ml glass scintillation vial respectively and
then adding HPLC grade tetrahydrofuran (THF). 1 g of a
MePEG(2000)-PDLLA (60:40) diblock copolymer is added to each vial.
The solutions are gently shaken on an orbital shaker for 6 hours at
room temperature. An electrical pacing lead that comprises a porous
ball shaped electrode tip (Medtronic, Inc.) is placed on a bench
and a glass microscope slide is placed under the tip portion of the
lead. Using a 200 uL Gilson pipettor with the pipette tip touching
the electrode tip, the 0.1 mg/ml paclitaxel solution is slowly
applied to the porous electrode tip until the electrode tip will
not absorb any more solution. The electrode is then allowed to air
dry for 6 hour. The process is repeated for all the prepared
paclitaxel solutions using a fresh electrode for each solution.
Example 28
Drug-Loading an Electrical Lead Comprising a Porous
Electrode--Paclitaxel/Beclomethasone/Polymer
[1094] Several saturated 10 ml acetone solutions of beclomethasone
diproprionate anhydrous are prepared by adding the beclomethasone
diproprionate anhydrous to 10 ml acetone in 20 ml glass
scintillation vials until no more beclomethasone diproprionate
anhydrous will dissolve and solid beclomethasone diproprionate
anhydrous remains at the bottom of the vial. To each of these
saturated solutions, 1 mg, 5 mg, 10 mg, 20 mg, 50 mg, 75 mg, 100
mg, 200 mg, and 500 mg paclitaxel are added respectively. 1 g of a
MePEG(2000)-PDLLA (60:40) diblock copolymer is added to each vial.
The solutions are gently shaken on an orbital shaker for 6 hours at
room temperature. An electrical pacing lead that comprises a porous
ball shaped electrode tip (Medtronic) is placed on a bench and a
glass microscope slide is placed under the tip portion of the lead.
Using a 200 uL Gilson pipettor with the pipette tip touching the
electode tip, the 0.1 mg/ml paclitaxel solution is slowly applied
to the porous electrode tip until the electrode tip will not absorb
any more solution. The electrode is then allowed to air dry for 6
hour. The process is repeated for all the prepared paclitaxel
solutions using a fresh electrode for each solution.
Example 29
Drug-Loading an Electrical Lead Comprising a Porous
Electrode--Paclitaxel Dipping
[1095] 10 ml solutions of paclitaxel are prepared by weighing in 1
mg, 5 mg, 10 mg, 20 mg, 50 mg, 75 mg, 100 mg, 200 mg, and 500 mg
paclitaxel into a 20 ml glass scintillation vial respectively and
then adding HPLC grade acetone. The solutions are gently shaken on
an orbital shaker for 1 hour at room temperature. The tip of an
electrical pacing lead that comprises a porous ball shaped
electrode tip (Medtronic, Inc.) is immersed to a depth of about 1
cm into the 0.1 mg/ml solution. After about 2 hours, the tip
portion is removed from the solution and is allowed to air dry for
6 hour. The electrode is further dried under vacuum for 24 hours.
The process is repeated for all the prepared paclitaxel solutions
using a fresh electrode for each solution.
Example 30
Drug-Loading an Electrical Lead Comprising a Porous
Electrode--Paclitaxel/Beclomethasone
[1096] Several saturated 10 ml acetone solutions of beclomethasone
diproprionate anhydrous are prepared by adding the beclomethasone
diproprionate anhydrous to 10 ml acetone in 20 ml glass
scintillation vials until no more beclomethasone diproprionate
anhydrous will dissolve and solid beclomethasone diproprionate
anhydrous remains at the bottom of the vial. To each of these
saturated solutions, 1 mg, 5 mg, 10 mg, 20 mg, 50 mg, 75 mg, 100
mg, 200 mg, and 500 mg paclitaxel are added respectively. The
solutions are gently shaken on an orbital shaker for 1 hour at room
temperature. The tip of an electrical pacing lead that comprises a
porous ball shaped electrode tip (Medtronic) is immersed to a depth
of about 1 cm into the 0.1 mg/ml solution. After about 2 hours, the
tip portion is removed from the solution and is allowed to air dry
for 6 hour. The electrode is further dried under vacuum for 24
hours. The process is repeated for all the prepared paclitaxel
solutions using a fresh electrode for each solution.
Example 31
Drug-Loading a Screw-In electrical Lead--Paclitaxel Dipping
[1097] 10 ml solutions of paclitaxel are prepared by weighing in 1
mg, 5 mg, 10 mg, 20 mg, 50 mg, 75 mg, 100 mg, 200 mg, and 500 mg
paclitaxel into a 20 ml glass scintillation vial respectively and
then adding HPLC grade methanol. The solutions are gently shaken on
an orbital shaker for 1 hour at room temperature. The tip of an
electrical pacing lead that comprises a screw in electrode tip
(e.g., CAPSUREFIX NOVUS 5076, Medtronic, Inc.) is immersed to a
depth of about 1 cm into the 0.1 mg/ml solution. After about 2
hours, the tip portion is removed from the solution and is allowed
to air dry for 6 hour. The electrode is further dried under vacuum
for 24 hours. The process is repeated for all the prepared
paclitaxel solutions using a fresh electrode for each solution.
Example 32
Drug-Loading a Screw-In Electrical Lead--Paclitaxel Dipping
[1098] 10 ml solutions of paclitaxel are prepared by weighing in 1
mg, 5 mg, 10 mg, 20 mg, 50 mg, 75 mg, 100 mg, 200 mg, and 500 mg
paclitaxel into a 20 ml glass scintillation vial respectively and
then adding HPLC grade methanol. The solutions are gently shaken on
an orbital shaker for 1 hour at room temperature. The tip of an
electrical pacing lead that comprises a screw in electrode tip
(e.g., CAPSUREFIX NOVUS 5076) is immersed to a depth of about 1 cm
into the 0.1 mg/ml solution. After about 2 hours, the tip portion
is removed from the solution and is allowed to air dry for 6 hour.
The electrode is further dried under vacuum for 24 hours. The
process is repeated for all the prepared paclitaxel solutions using
a fresh electrode for each solution.
Example 33
Drug-Loading a Screw-In Electrical Lead--Paclitaxel/Polymer
Dipping
[1099] A polyurethane solution (CHRONOFLEX AL 85 A) is prepared by
dissolving 20 g of the polyurethane in 200 ml tetrahydrofuran
(THF). 10 ml aliquots of this solution are placed in 20 ml glass
scintillation vials. 1 mg, 5 mg, 10 mg, 20 mg, 50 mg, 75 mg, 100
mg, 200 mg, and 500 mg paclitaxel are then added to each of the
vials respectively. The solutions are tumbled for 3 hours at 20
rpm. The tip of an electrical pacing lead that comprises a screw in
electrode tip (e.g., CAPSUREFIX NOVUS 5076) is immersed to a depth
of about 1 cm into the 0.1 mg/ml paclitaxel solution and then it is
slowly withdrawn from the solution. The coated portion is allowed
to air dry for 10 min. The screw-in portion of the electrode is
then immersed in a solution of HPLC grade THF. After 1 hour the
screw-in portion of the electrode is removed from the THF solution
and is immersed in a fresh THF solution for 30 min. The electrode
is then removed from the THF solution and is allowed to air dry for
2 hour. The electrode is further dried under vacuum for 24 hours.
The process is repeated for all the prepared paclitaxel solutions
using a fresh electrode for each solution.
Example 34
Drug-Loading a Screw-In Electrical Lead--Halofuginone/Polymer
Spraying
[1100] A polyurethane solution (CHRONOFLEX AL 85 A) is prepared by
dissolving 20 g of the polyurethane in 200 ml tetrahydrofuran
(THF). 10 ml aliquots of this solution are placed in 20 ml glass
scintillation vials. 1 mg, 5 mg, 10 mg, 20 mg, 50 mg, 75 mg, 100
mg, 200 mg, and 500 mg halofuginone are then added to each of the
vials respectively. The solutions are tumbled for 3 hours at 20
rpm. The tip of an electrical pacing lead that comprises a screw in
electrode tip (e.g., CAPSUREFIX NOVUS 5076) is screwed into the end
of a silastic rod until the screw-in portion is completely
incorporated into the silastic rod. The silastic rod it the
attached to an overhead stirrer and the stir speed is set at 40
rpm. The 0.1 mg/ml halofuginone solution is placed in a 3 ml glass
syringe that is then attached to an ultrasonic spray head (Sonus,
Inc). The syringe is placed in a syringe pump. The solution is then
sprayed onto the tip portion of the lead at a flow rate of 0.5
ml/min. Once the electrical lead tip is evenly coated with a
halofuginone/polymer solution, the spraying is stopped and the
coating is allowed to air dry for 1 hour. The electrode is
unscrewed from the silastic rod. The electrode is further dried
under vacuum for 24 hours. The process is repeated for all the
prepared halofuginone solutions using a fresh electrode each
time.
Example 35
Drug-Loading an Electrode Annular Shaped Monolithic Controlled
Release Device--Paclitaxel
[1101] 10 ml solutions of paclitaxel are prepared by weighing in 1
mg, 5 mg, 10 mg, 20 mg, 50 mg, 75 mg, 100 mg, 200 mg, and 500 mg
paclitaxel into a 20 ml glass scintillation vial respectively and
then adding HPLC grade methanol. The solutions are gently shaken on
an orbital shaker for 1 hour at room temperature. A silicone rubber
annular shaped monolithic controlled release device used in the
construction of a CAPSURE Z lead (Model 5534, Medtronic, Inc), is
immersed in the 0.1 mg/ml paclitaxel solution for 3 hours. Using a
pair of tweezers, the silicone rubber piece is removed from the
solution, gently shaken to remove the excess solution and is then
air dried for 5 hour. The air dried component is then dried under
vacuum for 24 hours. The drug loaded silicone rubber component is
then used in the assembly of the lead.
Example 36
Drug-Loading an Electrode Annular Shaped Monolithic Controlled
Release Device--Paclitaxel/Dexamethasone
[1102] Several saturated 10 ml methanol solutions of dexamethasone
are prepared by adding the dexamethasone to 10 ml methanol in 20 ml
glass scintillation vials until no more dexamethasone will dissolve
and solid dexamethasone remains at the bottom of the vial. To each
of these saturated solutions, 1 mg, 5 mg, 10 mg, 20 mg, 50 mg, 75
mg, 100 mg, 200 mg, and 500 mg paclitaxel are added respectively.
The solutions are gently shaken on an orbital shaker for 1 hour at
room temperature. A silicone rubber annular shaped monolithic
controlled release device used in the construction of a CAPSURE Z
lead (Medtronic, Inc) is immersed in the 0.1 mg/ml paclitaxel
solution for 3 hours. Using a pair of tweezers, the silicone rubber
piece is removed from the solution, gently shaken to remove the
excess solution and is then air dried for 5 hour. The air dried
component is then dried under vacuum for 24 hours. The drug loaded
silicone rubber component is then used in the assembly of the
lead.
Example 37
Drug-Loading A Screw-In Electrical Lead--Rapamycin/Polymer Dip
Coating
[1103] A polyurethane solution (CHRONOFLEX AL 85 A) is prepared by
dissolving 20 g of the polyurethane in 200 ml tetrahydrofuran
(THF). 10 ml aliquots of this solution are placed in 20 ml glass
scintillation vials. 1 mg, 5 mg, 10 mg, 20 mg, 50 mg, 75 mg, 100
mg, 200 mg, and 500 mg rapamycin are then added to each of the
vials respectively. The solutions are tumbled for 3 hours at 20
rpm. The tip of an electrical pacing lead that comprises a screw in
electrode tip (e.g., CAPSUREFIX NOVUS 5076, Medtronic, Inc.) is
screwed into the end of a silastic rod until the screw-in portion
is completely incorporated into the silastic rod. The 0.1 mg/ml
rapamycin solution is placed in a thin glass tube that is sealed at
one end. The electrical lead is dipped into the solution and is
then gradually withdrawn from the solution. The coated electrode is
clamped such that the coated portion is suspended in the air. The
coating is then air dried for 1 hour. The electrode is unscrewed
from the silastic rod. The electrode is further dried under vacuum
for 24 hours. The process is repeated for all the prepared
rapamycin solutions using a fresh electrode each time.
Example 38
Screening Assay for Assessing the Effect of Various Compounds on
Nitric Oxide Production by Macrophages
[1104] The murine macrophage cell line RAW 264.7 was trypsinized to
remove cells from flasks and plated in individual wells of a 6-well
plate. Approximately 2.times.10.sup.6 cells were plated in 2 mL of
media containing 5% heat-inactivated fetal bovine serum (FBS). RAW
264.7 cells were incubated at 37.degree. C. for 1.5 hours to allow
adherence to plastic. Mitoxantrone was prepared in DMSO at a
concentration of 10.sup.-2 M and serially diluted 10-fold to give a
range of stock concentrations (10.sup.-8 M to 10.sup.-2 M). Media
was then removed and cells were incubated in 1 ng/mL of recombinant
murine IFN.gamma. and 5 ng/mL of LPS with or without mitoxantrone
in fresh media containing 5% FBS. Mitoxantrone was added to cells
by directly adding mitoxantrone DMSO stock solutions, prepared
earlier, at a {fraction (1/1000)} dilution, to each well. Plates
containing IFN.gamma., LPS plus or minus mitoxantrone were
incubated at 37.degree. C. for 24 hours (Chem. Ber. (1879) 12: 426;
J. AOAC (1977)60-594; Ann. Rev. Biochem. (1994)63:175).
[1105] At the end of the 24 hour period, supernatants were
collected from the cells and assayed for the production of
nitrites. Each sample was tested in triplicate by aliquoting 50
.mu.l of supernatant in a 96-well plate and adding 50 .mu.l of
Greiss Reagent A (0.5 g sulfanilamide, 1.5 mL H.sub.3PO.sub.4, 48.5
mL ddH.sub.2O) and 50 .mu.l of Greiss Reagent B (0.05 g
N-(1-naphthyl)-ethylenediamine, 1.5 mL H.sub.3PO.sub.4, 48.5 mL
ddH.sub.2O). Optical density was read immediately on microplate
spectrophotometer at 562 nm absorbance. Absorbance over triplicate
wells was averaged after subtracting background and concentration
values were obtained from the nitrite standard curve (1 .mu.M to 2
mM). Inhibitory concentration of 50% (IC.sub.50) was determined by
comparing average nitrite concentration to the positive control
(cell stimulated with IFN.gamma. and LPS). An average of n=4
replicate experiments was used to determine IC.sub.50 values for
mitoxantrone (see, FIG. 2 (IC.sub.50=927 nM)). The IC.sub.50 values
for the following additional compounds were determined using this
assay: IC.sub.50 (nM): paclitaxel, 7; CNI-1493, 249; halofuginone,
12; geldanamycin, 51; anisomycin, 68; 17-AAG, 840; epirubicin
hydrochloride, 769.
Example 39
Screening Assay for Assessing the Effect of Various Agents on
TNF-Alpha Production by Macrophages
[1106] The human macrophage cell line, THP-1 was plated in a 12
well plate such that each well contains 1.times.10.sup.6 cells in 2
mL of media containing 10% FCS. Opsonized zymosan was prepared by
resuspending 20 mg of zymosan A in 2 mL of ddH.sub.2O and
homogenizing until a uniform suspension was obtained. Homogenized
zymosan was pelleted at 250 g and resuspended in 4 mL of human
serum for a final concentration of 5 mg/mL and incubated in a
37.degree. C. water bath for 20 minutes to enable opsonization. Bay
11-7082 was prepared in DMSO at a concentration of 10.sup.-2 M and
serially diluted 10-fold to give a range of stock concentrations
(10.sup.-8 M to 10.sup.-2 M) (J. Immunol. (2000) 165: 411-418; J.
Immunol. (2000) 164: 4804-4811; J. Immunol Meth. (2000) 235 (1-2):
33-40).
[1107] THP-1 cells were stimulated to produce TNF.alpha. by the
addition of 1 mg/mL opsonized zymosan. Bay 11-7082 was added to
THP-1 cells by directly adding DMSO stock solutions, prepared
earlier, at a {fraction (1/1000)} dilution, to each well. Each drug
concentration was tested in triplicate wells. Plates were incubated
at 37.degree. C. for 24 hours.
[1108] After a 24 hour stimulation, supernatants were collected to
quantify TNF.alpha. production. TNF.alpha. concentrations in the
supernatants were determined by ELISA using recombinant human
TNF.alpha. to obtain a standard curve. A 96-well MaxiSorb plate was
coated with 100 .mu.l of anti-human TNF.alpha. Capture Antibody
diluted in Coating Buffer (0.1 M sodium carbonate pH 9.5) overnight
at 4.degree. C. The dilution of Capture Antibody used was
lot-specific and was determined empirically. Capture antibody was
then aspirated and the plate washed 3 times with Wash Buffer (PBS,
0.05% TWEEN-20). Plates were blocked for 1 hour at room temperature
with 200 .mu.l/well of Assay Diluent (PBS, 10% FCS pH 7.0). After
blocking, plates were washed 3 times with Wash Buffer. Standards
and sample dilutions were prepared as follows: (a) sample
supernatants were diluted 1/8 and {fraction (1/16)}; (b)
recombinant human TNF.alpha. was prepared at 500 pg/mL and serially
diluted to yield as standard curve of 7.8 pg/mL to 500 pg/mL.
Sample supernatants and standards were assayed in triplicate and
were incubated at room temperature for 2 hours after addition to
the plate coated with Capture Antibody. The plates were washed 5
times and incubated with 100 pi of Working Detector (biotinylated
anti-human TNF.alpha. detection antibody+avidin-HRP) for 1 hour at
room temperature. Following this incubation, the plates were washed
7 times and 100 .mu.l of Substrate Solution (tetramethylbenzidine,
H.sub.2O.sub.2) was added to plates and incubated for 30 minutes at
room temperature. Stop Solution (2 N H.sub.2SO.sub.4) was then
added to the wells and a yellow color reaction was read at 450 nm
with .lambda. correction at 570 nm. Mean absorbance was determined
from triplicate data readings and the mean background was
subtracted. TNF.alpha. concentration values were obtained from the
standard curve. Inhibitory concentration of 50% (IC.sub.50) was
determined by comparing average TNF.alpha. concentration to the
positive control (THP-1 cells stimulated with opsonized zymosan).
An average of n=4 replicate experiments was used to determine
IC.sub.50 values for Bay 11-7082 (see FIG. 3; IC.sub.50=810 nM))
and rapamycin (IC.sub.50=51 nM; FIG. 4). The IC.sub.50 values for
the following additional compounds were determined using this
assay: IC.sub.50 (nM): geldanamycin, 14; mycophenolic acid, 756;
mofetil, 792; chlorpromazine, 6; CNI-1493, 0.15; SKF 86002, 831;
15-deoxy prostaglandin J2, 742; fascaplysin, 701; podophyllotoxin,
75; mithramycin, 570; daunorubicin, 195; celastrol, 87; chromomycin
A3, 394; vinorelbine, 605; vinblastine, 65.
Example 40
Surgical Adhesions Model to Assess Fibrosis Inhibiting Agents in
Rats
[1109] The rat caecal sidewall model is used to as to assess the
anti-fibrotic capacity of formulations in vivo. Sprague Dawley rats
are anesthetized with halothane. Using aseptic precautions, the
abdomen is opened via a midline incision. The caecum is exposed and
lifted out of the abdominal cavity. Dorsal and ventral aspects of
the caecum are successively scraped a total of 45 times over the
terminal 1.5 cm using a #10 scalpel blade. Blade angle and pressure
are controlled to produce punctate bleeding while avoiding severe
tissue damage. The left side of the abdomen is retracted and
everted to expose a section of the peritoneal wall that lies
proximal to the caecum. The superficial layer of muscle
(transverses abdominis) is excised over an area of 1.times.2
cm.sup.2, leaving behind tom fibres from the second layer of muscle
(internal oblique muscle). Abraded surfaces are tamponaded until
bleeding stops. The abraded caecum is then positioned over the
sidewall wound and attached by two sutures. The formulation is
applied over both sides of the abraded caecum and over the abraded
peritoneal sidewall. A further two sutures are placed to attach the
caecum to the injured sidewall by a total of 4 sutures and the
abdominal incision is closed in two layers. After 7 days, animals
are evaluated post mortem with the extent and severity of adhesions
being scored both quantitatively and qualitatively.
Example 41
Surgical Adhesions Model to Assess Fibrosis Inhibiting Agents in
Rabbits
[1110] The rabbit uterine horn model is used to assess the
anti-fibrotic capacity of formulations in vivo. Mature New Zealand
White (NZW) female rabbits are placed under general anesthetic.
Using aseptic precautions, the abdomen is opened in two layers at
the midline to expose the uterus. Both uterine horns are lifted out
of the abdominal cavity and assessed for size on the French Scale
of catheters. Horns between #8 and #14 on the French Scale (2.5-4.5
mm diameter) are deemed suitable for this model. Both uterine horns
and the opposing peritoneal wall are abraded with a #10 scalpel
blade at a 45.degree. angle over an area 2.5 cm in length and 0.4
cm in width until punctuate bleeding is observed. Abraded surfaces
are tamponaded until bleeding stops. The individual horns are then
opposed to the peritoneal wall and secured by two sutures placed 2
mm beyond the edges of the abraded area. The formulation is applied
and the abdomen is closed in three layers. After 14 days, animals
are evaluated post mortem with the extent and severity of adhesions
being scored both quantitatively and qualitatively.
Example 42
Screening Assay for Assessing the Effect of Various Compounds on
Cell Proliferation
[1111] Fibroblasts at 70-90% confluency were trypsinized, replated
at 600 cells/well in media in 96-well plates and allowed to attach
overnight. Mitoxantrone was prepared in DMSO at a concentration of
10.sup.-2 M and diluted 10-fold to give a range of stock
concentrations (10.sup.-8 M to 10.sup.-2 M). Drug dilutions were
diluted {fraction (1/1000)} in media and added to cells to give a
total volume of 200 .mu.l/well. Each drug concentration was tested
in triplicate wells. Plates containing fibroblasts and mitoxantrone
were incubated at 37.degree. C. for 72 hours (In vitro toxicol.
(1990) 3: 219; Biotech. Histochem. (1993) 68: 29; Anal. Biochem.
(1993) 213: 426).
[1112] To terminate the assay, the media was removed by gentle
aspiration. A {fraction (1/400)} dilution of CYQUANT 400.times. GR
dye indicator (Molecular Probes; Eugene, Oreg.) was added to
1.times. Cell Lysis buffer, and 200 .mu.l of the mixture was added
to the wells of the plate. Plates were incubated at room
temperature, protected from light for 3-5 minutes. Fluorescence was
read in a fluorescence microplate reader at .about.480 nm
excitation wavelength and .about.520 nm emission maxima. Inhibitory
concentration of 50% (IC.sub.50) was determined by taking the
average of triplicate wells and comparing average relative
fluorescence units to the DMSO control. An average of n=4 replicate
experiments was used to determine IC.sub.50 values. The IC.sub.50
values for the following compounds were determined using this
assay: IC.sub.50 (nM): mitoxantrone, 20 (FIG. 5); rapamycin, 19
(FIG. 6); paclitaxel, 23 (FIG. 7); mycophenolic acid, 550; mofetil,
601; GW8510, 98; simvastatin, 885; doxorubicin, 84; geldanamycin,
11; anisomycin, 435; 17-AAG, 106; bleomycin, 86; halofuginone, 36;
gemfibrozil, 164; ciprofibrate, 503; bezafibrate, 184; epirubicin
hydrochloride, 57; topotemay, 81; fascaplysin, 854; tamoxifen, 13;
etanidazole, 55; gemcitabine, 7; puromycin, 254; mithramycin, 156;
daunorubicin, 51; L(-)-perillyl alcohol, 966; celastrol, 271;
anacitabine, 225; oxalipatin, 380; chromomycin A3, 4; vinorelbine,
4; idarubicin, 34; nogalamycin, 5; 17-DMAG, 5; epothilone D, 2;
vinblastine, 2; vincristine, 7; cytarabine, 137.
Example 43
Evaluation of Paclitaxel Containing Mesh on Intimal Hyperplasia
Development in a Rat Balloon Injury Carotid Artery Model as an
Example to Evaluate Fibrosis Inhibiting Agents
[1113] A rat balloon injury carotid artery model was used to
demonstrate the efficacy of a paclitaxel containing mesh system on
the development of intimal hyperplasia fourteen days following
placement.
[1114] Control Group
[1115] Wistar rats weighing 400-500 g were anesthetized with 1.5%
halothane in oxygen and the left external carotid artery was
exposed. An A 2 French FOGARTY balloon embolectomy catheter
(Baxter, Irvine, Calif.) was advanced through an arteriotomy in the
external carotid artery down the left common carotid artery to the
aorta. The balloon was inflated with enough saline to generate
slight resistance (approximately 0.02 ml) and it was withdrawn with
a twisting motion to the carotid bifurcation. The balloon was then
deflated and the procedure repeated twice more. This technique
produced distension of the arterial wall and denudation of the
endothelium. The external carotid artery was ligated after removal
of the catheter. The right common carotid artery was not injured
and was used as a control.
[1116] Local Perivascular Paclitaxel Treatment
[1117] Immediately after injury of the left common carotid artery,
a 1 cm long distal segment of the artery was exposed and treated
with a 1.times.1 cm paclitaxel-containing mesh (345 .mu.g
paclitaxel in a 50:50 PLG coating on a 10:90 PLG mesh). The wound
was then closed the animals were kept for 14 days.
[1118] Histology and Immunohistochemistry
[1119] At the time of sacrifice, the animals were euthanized with
carbon dioxide and pressure perfused at 100 mmHg with 10% phosphate
buffered formaldehyde for 15 minutes. Both carotid arteries were
harvested and left overnight in fixative. The fixed arteries were
processed and embedded in paraffin wax. Serial cross-sections were
cut at 3 .mu.m thickness every 2 mm within and outside the implant
region of the injured left carotid artery and at corresponding
levels in the control right carotid artery. Cross-sections were
stained with Mayer's hematoxylin-and-eosin for cell count and with
Movat's pentachrome stains for morphometry analysis and for
extracellular matrix composition assessment.
[1120] Results
[1121] From FIGS. 8-10, it is evident that the perivascular
delivery of paclitaxel using the paclitaxel mesh formulation
resulted is a dramatic reduction in intimal hyperplasia.
Example 44
Effect of Paclitaxel and other Anti-Microtubule Agents on Matrix
Metalloproteinase Production
[1122] A. Materials and Methods
[1123] 1. IL-1 Stimulated AP-1 Transcriptional Activity is
Inhibited by Paclitaxel
[1124] Chondrocytes were transfected with constructs containing an
AP-1 driven CAT reporter gene, and stimulated with IL-1, IL-1 (50
ng/ml) was added and incubated for 24 hours in the absence and
presence of paclitaxel at various concentrations. Paclitaxel
treatment decreased CAT activity in a concentration dependent
manner (mean.+-.SD). The data noted with an asterisk (*) have
significance compared with IL-1-induced CAT activity according to a
t-test, P<0.05. The results shown are representative of three
independent experiments.
[1125] 2. Effect of Paclitaxel on IL-1 Induced AP-1 DNA Binding
Activity, AP-1 DNA
[1126] Binding activity was assayed with a radiolabeled human AP-1
sequence probe and gel mobility shift assay. Extracts from
chondrocytes untreated or treated with various amounts of
paclitaxel (10.sup.-7 to 10.sup.-5 M) followed by IL-1.beta. (20
ng/ml) were incubated with excess probe on ice for 30 minutes,
followed by non-denaturing gel electrophoresis. The "com" lane
contains excess unlabeled AP-1 oligonucleotide. The results shown
are representative of three independent experiments.
[1127] 3. Effect of Paclitaxel on IL-1 Induced MMP-1 and MMP-3 mRNA
Expression
[1128] Cells were treated with paclitaxel at various concentrations
(10.sup.-7 to 10.sup.-5 M) for 24 hours, then treated with
IL-1.beta. (20 ng/ml) for additional 18 hours in the presence of
paclitaxel. Total RNA was isolated, and the MMP-1 mRNA levels were
determined by Northern blot analysis. The blots were subsequently
stripped and reprobed with .sup.32P-radiolabeled rat GAPDH cDNA,
which was used as a housekeeping gene. The results shown are
representative of four independent experiments. Quantitation of
collagenase-1 and stromelysin-expression mRNA levels was conducted.
The MMP-1 and MMP-3 expression levels were normalized with
GAPDH.
[1129] 4. Effect of other Anti-Microtubules on Collagenase
Expression
[1130] Primary chondrocyte cultures were freshly isolated from calf
cartilage. The cells were plated at 2.5.times.10.sup.6 per ml in
100.times.20 mm culture dishes and incubated in Ham's F12 medium
containing 5% FBS overnight at 37.degree. C. The cells were starved
in serum-free medium overnight and then treated with
anti-microtubule agents at various concentrations for 6 hours. IL-1
(20 ng/ml) was then added to each plate and the plates incubated
for an additional 18 hours. Total RNA was isolated by the acidified
guanidine isothiocyanate method and subjected to electrophoresis on
a denatured gel. Denatured RNA samples (15 .mu.g) were analyzed by
gel electrophoresis in a 1% denatured gel, transferred to a nylon
membrane and hydridized with the .sup.32P-labeled collagenase cDNA
probe. .sup.32P-labeled glyceraldehyde phosphate dehydrase (GAPDH)
cDNA as an internal standard to ensure roughly equal loading. The
exposed films were scanned and quantitatively analyzed with
IMAGEQUANT.
[1131] B. Results
[1132] 1. Promoters on the Family of Matrix Metalloproteinases
[1133] FIG. 11A shows that all matrix metalloproteinases contained
the transcriptional elements AP-1 and PEA-3 with the exception of
gelatinase B. It has been well established that expression of
matrix metalloproteinases such as collagenases and stromelysins are
dependent on the activation of the transcription factors AP-1. Thus
inhibitors of AP-1 may inhibit the expression of matrix
metalloproteinases.
[1134] 2. Effect of Paclitaxel on AP-1 Transcriptional Activity
[1135] As demonstrated in FIG. 11B, IL-1 stimulated AP-1
transcriptional activity 5-fold. Pretreatment of transiently
transfected chondrocytes with paclitaxel reduced IL-1 induced AP-1
reporter gene CAT activity. Thus, IL-1 induced AP-1 activity was
reduced in chondrocytes by paclitaxel in a concentration dependent
manner (10.sup.-7 to 10.sup.-5 M). These data demonstrated that
paclitaxel was a potent inhibitor of AP-1 activity in
chondrocytes.
[1136] 3. Effect of Paclitaxel on AP-1 DNA Binding Activity
[1137] To confirm that paclitaxel inhibition of AP-1 activity was
not due to nonspecific effects, the effect of paclitaxel on IL-1
induced AP-1 binding to oligonucleotides using chondrocyte nuclear
lysates was examined. As shown in FIG. 11C, IL-1 induced binding
activity decreased in lysates from chondrocyte which had been
pretreated with paclitaxel at concentration 10.sup.-7 to 10.sup.-5
M for 24 hours. Paclitaxel inhibition of AP-1 transcriptional
activity closely correlated with the decrease in AP-1 binding to
DNA.
[1138] 4. Effect of Paclitaxel on Collagenase and Stromelysin
Expression
[1139] Since paclitaxel was a potent inhibitor of AP-1 activity,
the effect of paclitaxel or IL-1 induced collagenase and
stromelysin expression, two important matrix metalloproteinases
involved in inflammatory diseases was examined. Briefly, as shown
in FIG. 11D, IL-1 induction increases collagenase and stromelysin
mRNA levels in chondrocytes. Pretreatment of chondrocytes with
paclitaxel for 24 hours significantly reduced the levels of
collagenase and stromelysin mRNA. At 10.sup.-5 M paclitaxel, there
was complete inhibition. The results show that paclitaxel
completely inhibited the expression of two matrix
metalloproteinases at concentrations similar to which it inhibits
AP-1 activity.
[1140] 5. Effect of Other Anti-Microtubules on Collagenase
Expression
[1141] FIGS. 12A-H demonstrate that anti-microtubule agents
inhibited collagenase expression. Expression of collagenase was
stimulated by the addition of IL-1 which is a proinflammatory
cytokine. Pre-incubation of chondrocytes with various
anti-microtubule agents, specifically LY290181, hexylene glycol,
deuterium oxide, glycine ethyl ester, ethylene glycol
bis-(succinimidylsuccinate), tubercidin, AIF.sub.3, and epothilone,
all prevented IL-1-induced collagenase expression at concentrations
as low as 1.times.10.sup.-7 M.
[1142] C. Discussion
[1143] Paclitaxel was capable of inhibiting collagenase and
stromelysin expression in vitro at concentrations of 10.sup.-6 M.
Since this inhibition may be explained by the inhibition of AP-1
activity, a required step in the induction of all matrix
metalloproteinases with the exception of gelatinase B, it is
expected that paclitaxel may inhibit other matrix
metalloproteinases which are AP-1 dependent. The levels of these
matrix metalloproteinases are elevated in all inflammatory diseases
and play a principle role in matrix degradation, cellular migration
and proliferation, and angiogenesis. Thus, paclitaxel inhibition of
expression of matrix metalloproteinases such as collagenase and
stromelysin can have a beneficial effect in inflammatory
diseases.
[1144] In addition to paclitaxel's inhibitory effect on collagenase
expression, LY290181, hexylene glycol, deuterium oxide, glycine
ethyl ester, AIF.sub.3, tubercidin epothilone, and ethylene glycol
bis-(succinimidylsuccinate), all prevented IL-1-induced collagenase
expression at concentrations as low as 1.times.10.sup.-7 M. Thus,
anti-microtubule agents are capable of inhibiting the AP-1 pathway
at varying concentrations.
Example 45
Inhibition of Angiogenesis by Paclitaxel
[1145] A. Chick Chorioallantoic Membrane ("CAM") Assays
[1146] Fertilized, domestic chick embryos were incubated for 3 days
prior to shell-less culturing. In this procedure, the egg contents
were emptied by removing the shell located around the air space.
The interior shell membrane was then severed and the opposite end
of the shell was perforated to allow the contents of the egg to
gently slide out from the blunted end. The egg contents were
emptied into round-bottom sterilized glass bowls and covered with
petri dish covers. These were then placed into an incubator at 90%
relative humidity and 3% CO.sub.2 and incubated for 3 days.
[1147] Paclitaxel (Sigma, St. Louis, Mich.) was mixed at
concentrations of 0.25, 0.5, 1, 5, 10, 30 .mu.g per 10 .mu.l
aliquot of 0.5% aqueous methylcellulose. Since paclitaxel is
insoluble in water, glass beads were used to produce fine
particles. Ten microliter aliquots of this solution were dried on
parafilm for 1 hour forming disks 2 mm in diameter. The dried disks
containing paclitaxel were then carefully placed at the growing
edge of each CAM at day 6 of incubation. Controls were obtained by
placing paclitaxel-free methylcellulose disks on the CAMs over the
same time course. After a 2.degree. day exposure (day 8 of
incubation) the vasculature was examined with the aid of a
stereomicroscope. Liposyn II, a white opaque solution, was injected
into the CAM to increase the visibility of the vascular details.
The vasculature of unstained, living embryos were imaged using a
Zeiss stereomicroscope which was interfaced with a video camera
(Dage-MTI Inc., Michigan City, Ind.). These video signals were then
displayed at 160.times. magnification and captured using an image
analysis system (Vidas, Kontron; Etching, Germany). Image negatives
were then made on a graphics recorder (Model 3000; Matrix
Instruments, Orangeburg, N.Y.).
[1148] The membranes of the 8 day-old shell-less embryo were
flooded with 2% glutaraldehyde in 0.1 M sodium cacodylate buffer;
additional fixative was injected under the CAM. After 10 minutes in
situ, the CAM was removed and placed into fresh fixative for 2
hours at room temperature. The tissue was then washed overnight in
cacodylate buffer containing 6% sucrose. The areas of interest were
postfixed in 1% osmium tetroxide for 1.5 hours at 4.degree. C. The
tissues were then dehydrated in a graded series of ethanols,
solvent exchanged with propylene oxide, and embedded in Spurr
resin. Thin sections were cut with a diamond knife, placed on
copper grids, stained, and examined in a Joel 1200EX electron
microscope. Similarly, 0.5 mm sections were cut and stained with
toluene blue for light microscopy.
[1149] At day 11 of development, chick embryos were used for the
corrosion casting technique. Mercox resin (Ted Pella, Inc.,
Redding, Calif.) was injected into the CAM vasculature using a
30-gauge hypodermic needle. The casting material consisted of 2.5
grams of Mercox CL-2B polymer and 0.05 grams of catalyst (55%
benzoyl peroxide) having a 5 minute polymerization time. After
injection, the plastic was allowed to sit in situ for an hour at
room temperature and then overnight in an oven at 65.degree. C. The
CAM was then placed in 50% aqueous solution of sodium hydroxide to
digest all organic components. The plastic casts were washed
extensively in distilled water, air-dried, coated with
gold/palladium, and viewed with the Philips 501 B scanning electron
microscope.
[1150] Results of the assay were as follows. At day 6 of
incubation, the embryo was centrally positioned to a radially
expanding network of blood vessels; the CAM developed adjacent to
the embryo. These growing vessels lie close to the surface and are
readily visible making this system an idealized model for the study
of angiogenesis. Living, unstained capillary networks of the CAM
may be imaged noninvasively with a stereomicroscope.
[1151] Transverse sections through the CAM show an outer ectoderm
consisting of a double cell layer, a broader mesodermal layer
containing capillaries which lie subjacent to the ectoderm,
adventitial cells, and an inner, single endodermal cell layer. At
the electron microscopic level, the typical structural details of
the CAM capillaries are demonstrated. Typically, these vessels lie
in close association with the inner cell layer of ectoderm.
[1152] After 48 hours exposure to paclitaxel at concentrations of
0.25, 0.5, 1, 5, 10, or 30 .mu.g, each CAM was examined under
living conditions with a stereomicroscope equipped with a
video/computer interface in order to evaluate the effects on
angiogenesis. This imaging setup was used at a magnification of
160.times. which permitted the direct visualization of blood cells
within the capillaries; thereby blood flow in areas of interest may
be easily assessed and recorded. For this study, the inhibition of
angiogenesis was defined as an area of the CAM (measuring 2-6 mm in
diameter) lacking a capillary network and vascular blood flow.
Throughout the experiments, avascular zones were assessed on a 4
point avascular gradient (Table 1). This scale represents the
degree of overall inhibition with maximal inhibition represented as
a 3 on the avascular gradient scale. Paclitaxel was very consistent
and induced a maximal avascular zone (6 mm in diameter or a 3 on
the avascular gradient scale) within 48 hours depending on its
concentration.
35TABLE 1 AVASCULAR GRADIENT 0 normal vascularity 1 lacking some
microvascular movement 2* small avascular zone approximately 2 mm
in diameter 3* avascularity extending beyond the disk (6 mm in
diameter) *indicates a positive antiangiogenesis response
[1153] The dose-dependent, experimental data of the effects of
paclitaxel at different concentrations are shown in Table 2.
36TABLE 2 Agent Delivery Vehicle Concentration Inhibition/n
paclitaxel methylcellulose (10 .mu.l) 0.25 .mu.g 2/11
methylcellulose (10 .mu.l) 0.5 .mu.g 6/11 methylcellulose (10
.mu.l) 1 .mu.g 6/15 methylcellulose (10 .mu.l) 5 .mu.g 20/27
methylcellulose (10 .mu.l) 10 .mu.g 16/21 methylcellulose (10
.mu.l) 30 .mu.g 31/31
[1154] Typical paclitaxel-treated CAMs are also shown with the
transparent methylcellulose disk centrally positioned over the
avascular zone measuring 6 mm in diameter. At a slightly higher
magnification, the periphery of such avascular zones is clearly
evident; the surrounding functional vessels were often redirected
away from the source of paclitaxel. Such angular redirecting of
blood flow was never observed under normal conditions. Another
feature of the effects of paclitaxel was the formation of blood
islands within the avascular zone representing the aggregation of
blood cells.
[1155] In summary, this study demonstrated that 48 hours after
paclitaxel application to the CAM, angiogenesis was inhibited. The
blood vessel inhibition formed an avascular zone which was
represented by three transitional phases of paclitaxel's effect.
The central, most affected area of the avascular zone contained
disrupted capillaries with extravasated red blood cells; this
indicated that intercellular junctions between endothelial cells
were absent. The cells of the endoderm and ectoderm maintained
their intercellular junctions and therefore these germ layers
remained intact; however, they were slightly thickened. As the
normal vascular area was approached, the blood vessels retained
their junctional complexes and therefore also remained intact. At
the periphery of the paclitaxel-treated zone, further blood vessel
growth was inhibited which was evident by the typical redirecting
or "elbowing" effect of the blood vessels.
Example 46
Screening Assay for Assessing the Effect of Paclitaxel on Smooth
Muscle Cell Migration
[1156] Primary human smooth muscle cells were starved of serum in
smooth muscle cell basal media containing insulin and human basic
fibroblast growth factor (bFGF) for 16 hours prior to the assay.
For the migration assay, cells were trypsinized to remove cells
from flasks, washed with migration media and diluted to a
concentration of 2-2.5.times.10.sup.5 cells/mL in migration media.
Migration media consists of phenol red free Dulbecco's Modified
Eagle Medium (DMEM) containing 0.35% human serum albumin. A 100
.mu.l volume of smooth muscle cells (approximately 20,000-25,000
cells) was added to the top of a Boyden chamber assembly (Chemicon
QCM CHEMOTAXIS 96-well migration plate). To the bottom wells, the
chemotactic agent, recombinant human platelet derived growth factor
(rhPDGF-BB) was added at a concentration of 10 ng/mL in a total
volume of 150 .mu.l. Paclitaxel was prepared in DMSO at a
concentration of 10.sup.-2 M and serially diluted 10-fold to give a
range of stock concentrations (10.sup.-8 M to 10.sup.-2 M).
Paclitaxel was added to cells by directly adding paclitaxel DMSO
stock solutions, prepared earlier, at a {fraction (1/1000)}
dilution, to the cells in the top chamber. Plates were incubated
for 4 hours to allow cell migration.
[1157] At the end of the 4 hour period, cells in the top chamber
were discarded and the smooth muscle cells attached to the
underside of the filter were detached for 30 minutes at 37.degree.
C. in Cell Detachment Solution (Chemicon). Dislodged cells were
lysed in lysis buffer containing the DNA binding CYQUANT GR dye and
incubated at room temperature for 15 minutes. Fluorescence was read
in a fluorescence microplate reader at .about.480 nm excitation
wavelength and .about.520 nm emission maxima. Relative fluorescence
units from triplicate wells were averaged after subtracting
background fluorescence (control chamber without chemoattractant)
and average number of cells migrating was obtained from a standard
curve of smooth muscle cells serially diluted from 25,000
cells/well down to 98 cells/well. Inhibitory concentration of 50%
(IC.sub.50) was determined by comparing the average number of cells
migrating in the presence of paclitaxel to the positive control
(smooth muscle cell chemotaxis in response to rhPDGF-BB). See FIG.
13 (IC.sub.50=0.76 nM). References: Biotechniques (2000) 29: 81; J.
Immunol Methods (2001) 254: 85.
Example 47
Screening Assay for Assessing the Effect of Various Compounds on
IL-1.beta. Production by Macrophages
[1158] The human macrophage cell line, THP-1 was plated in a 12
well plate such that each well contains 1.times.10.sup.6 cells in 2
mL of media containing 10% FCS. Opsonized zymosan was prepared by
resuspending 20 mg of zymosan A in 2 mL of ddH.sub.2O and
homogenizing until a uniform suspension was obtained. Homogenized
zymosan was pelleted at 250 g and resuspended in 4 mL of human
serum for a final concentration of 5 mg/mL and incubated in a
37.degree. C. water bath for 20 minutes to enable opsonization.
Geldanamycin was prepared in DMSO at a concentration of 10.sup.-2 M
and serially diluted 10-fold to give a range of stock
concentrations (10.sup.-8 M to 10.sup.-2 M).
[1159] THP-1 cells were stimulated to produce IL-1.beta. by the
addition of 1 mg/mL opsonized zymosan. Geldanamycin was added to
THP-1 cells by directly adding DMSO stock solutions, prepared
earlier, at a {fraction (1/1000)} dilution, to each well. Each drug
concentration was tested in triplicate wells. Plates were incubated
at 37.degree. C. for 24 hours.
[1160] After a 24 hour stimulation, supernatants were collected to
quantify IL-1.beta. production. IL-1.beta. concentrations in the
supernatants were determined by ELISA using recombinant human
IL-1.beta. to obtain a standard curve. A 96-well MaxiSorb plate was
coated with 100 .mu.l of anti-human IL-1.beta. Capture Antibody
diluted in Coating Buffer (0.1 M Sodium carbonate pH 9.5) overnight
at 4.degree. C. The dilution of Capture Antibody used was
lot-specific and was determined empirically. Capture antibody was
then aspirated and the plate washed 3 times with Wash Buffer (PBS,
0.05% TWEEN-20). Plates were blocked for 1 hour at room temperature
with 200 .mu.l/well of Assay Diluent (PBS, 10% FCS pH 7.0). After
blocking, plates were washed 3 times with Wash Buffer. Standards
and sample dilutions were prepared as follows: (a) sample
supernatants were diluted 1/4 and 1/8; (b) recombinant human
IL-1.beta. was prepared at 1000 pg/mL and serially diluted to yield
as standard curve of 15.6 pg/mL to 1000 pg/mL. Sample supernatants
and standards were assayed in triplicate and were incubated at room
temperature for 2 hours after addition to the plate coated with
Capture Antibody. The plates were washed 5 times and incubated with
100 .mu.l of Working Detector (biotinylated anti-human IL-1.beta.
detection antibody+avidin-HRP) for 1 hour at room temperature.
Following this incubation, the plates were washed 7 times and 100
.mu.l of Substrate Solution (Tetramethylbenzidine, H.sub.2O.sub.2)
was added to plates and incubated for 30 minutes at room
temperature. Stop Solution (2 N H.sub.2SO.sub.4) was then added to
the wells and a yellow color reaction was read at 450 nm with
.lambda. correction at 570 nm. Mean absorbance was determined from
triplicate data readings and the mean background was subtracted.
IL-1.beta. concentration values were obtained from the standard
curve. Inhibitory concentration of 50% (IC.sub.50) was determined
by comparing average IL-1.beta. concentration to the positive
control (THP-1 cells stimulated with opsonized zymosan). An average
of n=4 replicate experiments was used to determine IC.sub.50 values
for geldanamycin (IC.sub.50=20 nM). See FIG. 14. The IC.sub.50
values for the following additional compounds were determined using
this assay: IC.sub.50 (nM): mycophenolic acid 2888 nM); anisomycin,
127; rapamycin, 0.48; halofuginone, 919; IDN-6556, 642; epirubicin
hydrochloride, 774; topotemay, 509; fascaplysin, 425; daunorubicin,
517; celastrol, 23; oxalipatin, 107; chromomycin A3, 148.
[1161] References: J. Immunol. (2000) 165: 411-418; J. Immunol.
(2000) 164: 4804-4811; J. Immunol Meth. (2000) 235 (1-2):
33-40.
Example 48
Screening Assay for Assessing the Effect of Various Compounds on
IL-8 Production by Macrophages
[1162] The human macrophage cell line, THP-1 was plated in a 12
well plate such that each well contains 1.times.10.sup.6 cells in 2
mL of media containing 10% FCS. Opsonized zymosan was prepared by
resuspending 20 mg of zymosan A in 2 mL of ddH.sub.2O and
homogenizing until a uniform suspension was obtained. Homogenized
zymosan was pelleted at 250 g, resuspended in 4 mL of human serum
for a final concentration of 5 mg/mL, and incubated in a 37.degree.
C. water bath for 20 minutes to enable opsonization. Geldanamycin
was prepared in DMSO at a concentration of 10.sup.-2 M and serially
diluted 10-fold to give a range of stock concentrations (10.sup.-8
M to 10.sup.-2 M).
[1163] THP-1 cells were stimulated to produce IL-8 by the addition
of 1 mg/mL opsonized zymosan. Geldanamycin was added to THP-1 cells
by directly adding DMSO stock solutions, prepared earlier, at a
{fraction (1/1000)} dilution, to each well. Each drug concentration
was tested in triplicate wells. Plates were incubated at 37.degree.
C. for 24 hours.
[1164] After a 24 hour stimulation, supernatants were collected to
quantify IL-8 production. IL-8 concentrations in the supernatants
were determined by ELISA using recombinant human IL-8 to obtain a
standard curve. A 96-well MAXISORB plate was coated with 100 .mu.l
of anti-human IL-8 Capture Antibody diluted in Coating Buffer (0.1
M sodium carbonate pH 9.5) overnight at 4.degree. C. The dilution
of Capture Antibody used was lot-specific and was determined
empirically. Capture antibody was then aspirated and the plate
washed 3 times with Wash Buffer (PBS, 0.05% TWEEN-20). Plates were
blocked for 1 hour at room temperature with 200 .mu.l/well of Assay
Diluent (PBS, 10% FCS pH 7.0). After blocking, plates were washed 3
times with Wash Buffer. Standards and sample dilutions were
prepared as follows: (a) sample supernatants were diluted {fraction
(1/100)} and {fraction (1/1000)}; (b) recombinant human IL-8 was
prepared at 200 pg/mL and serially diluted to yield as standard
curve of 3.1 pg/mL to 200 pg/mL. Sample supernatants and standards
were assayed in triplicate and were incubated at room temperature
for 2 hours after addition to the plate coated with Capture
Antibody. The plates were washed 5 times and incubated with 100
.mu.l of Working Detector (biotinylated anti-human IL-8 detection
antibody+avidin-HRP) for 1 hour at room temperature. Following this
incubation, the plates were washed 7 times and 100 .mu.l of
Substrate Solution (Tetramethylbenzidine, H.sub.2O.sub.2) was added
to plates and incubated for 30 minutes at room temperature. Stop
Solution (2 N H.sub.2SO.sub.4) was then added to the wells and a
yellow color reaction was read at 450 nm with .lambda. correction
at 570 nm. Mean absorbance was determined from triplicate data
readings and the mean background was subtracted. IL-8 concentration
values were obtained from the standard curve. Inhibitory
concentration of 50% (IC.sub.50) was determined by comparing
average IL-8 concentration to the positive control (THP-1 cells
stimulated with opsonized zymosan). An average of n=4 replicate
experiments was used to determine IC.sub.50 values for geldanamycin
(IC.sub.50=27 nM). See FIG. 15. The IC.sub.50 values for the
following additional compounds were determined using this assay:
IC.sub.50 (nM): 17-AAG, 56; mycophenolic acid, 549; resveratrol,
507; rapamycin, 4; 41; SP600125, 344; halofuginone, 641;
D-mannose-6-phosphate, 220; epirubicin hydrochloride, 654;
topotemay, 257; mithramycin, 33; daunorubicin, 421; celastrol, 490;
chromomycin A3, 36.
[1165] References: J. Immunol. (2000) 165: 411-418; J. Immunol.
(2000) 164: 4804-4811; J. Immunol Meth. (2000) 235 (1-2):
33-40.
Example 49
Screening Assay for Assessing the Effect of Various Compounds on
MCP-1 Production by Macrophages
[1166] The human macrophage cell line, THP-1 was plated in a 12
well plate such that each well contains 1.times.10.sup.6 cells in 2
mL of media containing 10% FCS. Opsonized zymosan was prepared by
resuspending 20 mg of zymosan A in 2 mL of ddH.sub.2O and
homogenizing until a uniform suspension was obtained. Homogenized
zymosan was pelleted at 250 g and resuspended in 4 mL of human
serum for a final concentration of 5 mg/mL and incubated in a
37.degree. C. water bath for 20 minutes to enable opsonization.
Geldanamycin was prepared in DMSO at a concentration of 10.sup.-2 M
and serially diluted 10-fold to give a range of stock
concentrations (10.sup.-8 M to 10.sup.-2 M).
[1167] THP-1 cells were stimulated to produce MCP-1 by the addition
of 1 mg/mL opsonized zymosan. Eldanamycin was added to THP-1 cells
by directly adding DMSO stock solutions, prepared earlier, at a
{fraction (1/1000)} dilution, to each well. Each drug concentration
was tested in triplicate wells. Plates were incubated at 37.degree.
C. for 24 hours.
[1168] After a 24 hour stimulation, supernatants were collected to
quantify MCP-1 production. MCP-1 concentrations in the supernatants
were determined by ELISA using recombinant human MCP-1 to obtain a
standard curve. A 96-well MaxiSorb plate was coated with 100 .mu.l
of anti-human MCP-1 Capture Antibody diluted in Coating Buffer
(0.1M Sodium carbonate pH 9.5) overnight at 4.degree. C. The
dilution of Capture Antibody used was lot-specific and was
determined empirically. Capture antibody was then aspirated and the
plate washed 3 times with Wash Buffer (PBS, 0.05% TWEEN-20). Plates
were blocked for 1 hour at room temperature with 200 .mu.l/well of
Assay Diluent (PBS, 10% FCS pH 7.0). After blocking, plates were
washed 3 times with Wash Buffer. Standards and sample dilutions
were prepared as follows: (a) sample supernatants were diluted
{fraction (1/100)} and {fraction (1/1000)}; (b) recombinant human
MCP-1 was prepared at 500 pg/mL and serially diluted to yield as
standard curve of 7.8 pg/mL to 500 pg/mL. Sample supernatants and
standards were assayed in triplicate and were incubated at room
temperature for 2 hours after addition to the plate coated with
Capture Antibody. The plates were washed 5 times and incubated with
100 .mu.l of Working Detector (biotinylated anti-human MCP-1
detection antibody+avidin-HRP) for 1 hour at room temperature.
Following this incubation, the plates were washed 7 times and 100
.mu.l of Substrate Solution (tetramethylbenzidine, H.sub.2O.sub.2)
was added to plates and incubated for 30 minutes at room
temperature. Stop Solution (2 N H.sub.2SO.sub.4) was then added to
the wells and a yellow color reaction was read at 450 nm with
.lambda. correction at 570 nm. Mean absorbance was determined from
triplicate data readings and the mean background was subtracted.
MCP-1 concentration values were obtained from the standard curve.
Inhibitory concentration of 50% (IC.sub.50) was determined by
comparing average MCP-1 concentration to the positive control
(THP-1 cells stimulated with opsonized zymosan). An average of n=4
replicate experiments was used to determine IC.sub.50 values for
geldanamycin (IC.sub.50=7 nM). See FIG. 16. The IC.sub.50 values
for the following additional compounds were determined using this
assay: IC.sub.50 (nM): 17-AAG, 135; anisomycin, 71; mycophenolic
acid, 764; mofetil, 217; mitoxantrone, 62; chlorpromazine, 0.011;
1-.alpha.-25 dihydroxy vitamin D.sub.3, 1; Bay 58-2667, 216;
15-deoxy prostaglandin J2, 724; rapamycin, 0.05; CNI-1493, 0.02;
BXT-51072, 683; halofuginone, 9; CYC 202, 306; topotemay, 514;
fascaplysin, 215; podophyllotoxin, 28; gemcitabine, 50; puromycin,
161; mithramycin, 18; daunorubicin, 570; celastrol, 421;
chromomycin A3, 37; vinorelbine, 69; tubercidin, 56; vinblastine,
19; vincristine, 16.
[1169] References: J. Immunol. (2000) 165: 411-418; J. Immunol.
(2000) 164: 4804-4811; J. Immunol Meth. (2000) 235 (1-2):
33-40.
Example 50
Screening Assay for Assessing the Effect of Paclitaxel on Cell
Proliferation
[1170] Smooth muscle cells at 70-90% confluency were trypsinized,
replated at 600 cells/well in media in 96-well plates and allowed
to attachment overnight. Paclitaxel was prepared in DMSO at a
concentration of 10.sup.-2 M and diluted 10-fold to give a range of
stock concentrations (10.sup.-8 M to 10.sup.-2 M). Drug dilutions
were diluted {fraction (1/1000)} in media and added to cells to
give a total volume of 200 .mu.l/well. Each drug concentration was
tested in triplicate wells. Plates containing cells and paclitaxel
were incubated at 37.degree. C. for 72 hours.
[1171] To terminate the assay, the media was removed by gentle
aspiration. A {fraction (1/400)} dilution of CYQUANT 400.times. GR
dye indicator (Molecular Probes; Eugene, Oreg.) was added to
1.times. Cell Lysis buffer, and 200 .mu.l of the mixture was added
to the wells of the plate. Plates were incubated at room
temperature, protected from light for 3-5 minutes. Fluorescence was
read in a fluorescence microplate reader at .about.480 nm
excitation wavelength and .about.520 nm emission maxima. Inhibitory
concentration of 50% (IC.sub.50) was determined by taking the
average of triplicate wells and comparing average relative
fluorescence units to the DMSO control. An average of n=3 replicate
experiments was used to determine IC.sub.50 values. See FIG. 17
(IC.sub.50=7 nM). The IC.sub.50 values for the following additional
compounds were determined using this assay: IC.sub.50 (nM):
mycophenolic acid, 579; mofetil, 463; doxorubicin, 64;
mitoxantrone, 1; geldanamycin, 5; anisomycin, 276; 17-AAG, 47;
cytarabine, 85; halofuginone, 81; mitomycin C, 53; etoposide, 320;
cladribine, 137; lovastatin, 978; epirubicin hydrochloride, 19;
topotemay, 51; fascaplysin, 510; podophyllotoxin, 21; cytochalasin
A, 221; gemcitabine, 9; puromycin, 384; mithramycin, 19;
daunorubicin, 50; celastrol, 493; chromomycin A3, 12; vinorelbine,
15; idarubicin, 38; nogalamycin, 49; itraconazole, 795; 17-DMAG,
17; epothilone D, 5; tubercidin, 30; vinblastine, 3; vincristine,
9.
[1172] This assay also may be used assess the effect of compounds
on proliferation of fibroblasts and murine macrophage cell line RAW
264.7. The results of the assay for assessing the effect of
paclitaxel on proliferation of murine RAW 264.7 macrophage cell
line were shown in FIG. 18 (IC.sub.50=134 nM).
[1173] Reference: In vitro toxicol. (1990) 3: 219; Biotech.
Histochem. (1993) 68: 29; Anal. Biochem. (1993) 213: 426.
Example 51
Perivascular Administration of Paclitaxel to Assess Inhibition of
Fibrosis
[1174] WISTAR rats weighing 250-300 g are anesthetized by the
intramuscular injection of Innovar (0.33 ml/kg). Once sedated, they
are then placed under halothane anesthesia. After general
anesthesia is established, fur over the neck region is shaved, the
skin clamped and swabbed with betadine. A vertical incision is made
over the left carotid artery and the external carotid artery
exposed. Two ligatures are placed around the external carotid
artery and a transverse arteriotomy is made. A number 2 French
Fogarty balloon catheter is then introduced into the carotid artery
and passed into the left common carotid artery and the balloon is
inflated with saline. The catheter is passed up and down the
carotid artery three times. The catheter is then removed and the
ligature is tied off on the left external carotid artery.
[1175] Paclitaxel (33%) in ethelyne vinyl acetate (EVA) is then
injected in a circumferential fashion around the common carotid
artery in ten rats. EVA alone is injected around the common carotid
artery in ten additional rats. (The paclitaxel may also be coated
onto an EVA film which is then placed in a circumferential fashion
around the common carotid artery.) Five rats from each group are
sacrificed at 14 days and the final five at 28 days. The rats are
observed for weight loss or other signs of systemic illness. After
14 or 28 days the animals are anesthetized and the left carotid
artery is exposed in the manner of the initial experiment. The
carotid artery is isolated, fixed at 10% buffered formaldehyde and
examined for histology. A statistically significant reduction in
the degree of initimal hyperplasia, as measured by standard
morphometric analysis, indicates a drug induced reduction in
fibrotic response.
Example 52
In vivo Evaluation of Silk Coated Perivascular PU Films to Assess
the Ability of an Agent to Induce Scarring
[1176] A rat carotid artery model is described for determining
whether a substance stimulates fibrosis. Wistar rats weighing 300 g
to 400 g are anesthetized with halothane. The skin over the neck
region is shaved and the skin is sterilized. A vertical incision is
made over the trachea and the left carotid artery is exposed. A
polyurethane film covered with silk strands or a control uncoated
PU film is wrapped around a distal segment of the common carotid
artery. The wound is closed and the animal is recovered. After 28
days, the rats are sacrificed with carbon dioxide and
pressure-perfused at 100 mmHg with 10% buffered formaldehyde. Both
carotid arteries are harvested and processed for histology. Serial
cross-sections can be cut every 2 mm in the treated left carotid
artery and at corresponding levels in the untreated right carotid
artery. Sections are stained with H&E and Movat's stains to
evaluate tissue growth around the carotid artery. Area of
perivascular granulation tissue is quantified by computer-assisted
morphometric analysis. Area of the granulation tissue is
significantly higher in the silk coated group than in the control
uncoated group. See FIG. 19. Other compounds may also be tested in
this manner to assess their ability to induce scarring.
Example 53
In vivo Evaluation of Perivascular PU Films Coated with Different
Silk Suture Material to Assess Scarring
[1177] A rat carotid artery model is described for determining
whether a substance stimulates fibrosis. Wistar rats weighing 300 g
to 400 g are anesthetized with halothane. The skin over the neck
region is shaved and the skin is sterilized. A vertical incision is
made over the trachea and the left carotid artery is exposed. A
polyurethane film covered with silk sutures from one of three
different manufacturers (3-0 Silk--Black Braided (Davis &
Geck), 3-0 SOFSILK (U.S. Surgical/Davis & Geck), and 3-0
Silk--Black Braided (LIGAPAK) (Ethicon, Inc.) is wrapped around a
distal segment of the common carotid artery. (The polyurethane film
can also be coated with other agents to induce fibrosis.) The wound
is closed and the animal is allowed to recover.
[1178] After 28 days, the rats are sacrificed with carbon dioxide
and pressure-perfused at 100 mmHg with 10% buffered formaldehyde.
Both carotid arteries are harvested and processed for histology.
Serial cross-sections are cut every 2 mm in the treated left
carotid artery and at corresponding levels in the untreated right
carotid artery. Sections are stained with H&E and Movat's
stains to evaluate tissue growth around the carotid artery. Area of
perivascular granulation tissue is quantified by computer-assisted
morphometric analysis. Thickness of the granulation tissue is the
same in the three groups showing that tissue proliferation around
silk suture is independent of manufacturing processes. See FIG.
20.
Example 54
In vivo Evaluation of Perivascular Silk Powder to Assess the
Capacity of an Agent to Induce Scarring
[1179] A rat carotid artery model is described for determining
whether a substance stimulates fibrosis. Wistar rats weighing 300 g
to 400 g are anesthetized with halothane. The skin over the neck
region is shaved and the skin is sterilized. A vertical incision is
made over the trachea and the left carotid artery is exposed. Silk
powder is sprinkled on the exposed artery that is then wrapped with
a PU film. Natural silk powder or purified silk powder (without
contaminant proteins) is used in different groups of animals.
Carotids wrapped with PU films only are used as a control group.
The wound is closed and the animal is allowed to recover. After 28
days, the rats are sacrificed with carbon dioxide and
pressure-perfused at 100 mmHg with 10% buffered formaldehyde. Both
carotid arteries are harvested and processed for histology. Serial
cross-sections can be cut every 2 mm in the treated left carotid
artery and at corresponding levels in the untreated right carotid
artery. Sections are stained with H&E and Movat's stains to
evaluate tissue growth around the carotid artery. Area of tunica
intima, tunica media and perivascular granulation tissue is
quantified by computer-assisted morphometric analysis.
[1180] The natural silk caused a severe cellular inflammation
consisting mainly of a neutrophil and lymphocyte infiltrate in a
fibrin network without any extracellular matrix or blood vessels.
In addition, the treated arteries were seriously damaged with
hypocellular media, fragmented elastic laminae and thick intimal
hyperplasia. Intimal hyperplasia contained many inflammatory cells
and was occlusive in 2/6 cases. This severe immune response was
likely triggered by antigenic proteins coating the silk protein in
this formulation. On the other end, the regenerated silk powder
triggered only a mild foreign body response surrounding the treated
artery. This tissue response was characterized by inflammatory
cells in extracellular matrix, giant cells and blood vessels. The
treated artery was intact. These results show that removing the
coating proteins from natural silk prevents the immune response and
promotes benign tissue growth. Degradation of the regenerated silk
powder was underway in some histology sections indicating that the
tissue response can likely mature and heal over time. See FIG.
21.
Example 55
In vivo Evaluation of Perivascular Talcum Powder to Assess the
Capacity of an Agent to Induce Scarring
[1181] A rat carotid artery model is described for determining
whether a substance stimulates fibrosis. Wistar rats weighing 300 g
to 400 g are anesthetized with halothane. The skin over the neck
region is shaved and the skin is sterilized. A vertical incision is
made over the trachea and the left carotid artery is exposed.
Talcum powder is sprinkled on the exposed artery that is then
wrapped with a PU film. Carotids wrapped with PU films only are
used as a control group. The wound is closed and the animal is
recovered. After 1 or 3 months, the rats are sacrificed with carbon
dioxide and pressure-perfused at 100 mmHg with 10% buffered
formaldehyde. Both carotid arteries are harvested and processed for
histology. Serial cross-sections are cut every 2 mm in the treated
left carotid artery and at corresponding levels in the untreated
right carotid artery. Sections are stained with H&E and Movat's
stains to evaluate tissue growth around the carotid artery.
Thickness of tunica intima, tunica media and perivascular
granulation tissue is quantified by computer-assisted morphometric
analysis. Histopathology results and morphometric analysis showed
the same local response to talcum powder at 1 month and 3 months. A
large tissue reaction trapped the talcum powder at the site of
application around the blood vessel. This tissue was characterized
by a large number of macrophages within a dense extracellular
matrix with few neutrophiles, lymphocytes and blood vessels. The
treated blood vessel appeared intact and unaffected by the
treatment. Overall, this result showed that talcum powder induced a
mild long-lasting fibrotic reaction that was subclinical in nature
and did not harm any adjacent tissue. See FIG. 22.
Example 56
MIC Determination by Microtitre Broth Dilution Method
[1182] A. MIC Assay of Various Gram Negative and Positive
Bacteria
[1183] MIC assays were conducted essentially as described by
Amsterdam, D. 1996, "Susceptibility testing of antimicrobials in
liquid media", p.52-111, in Loman, V., ed. Antibiotics in
laboratory medicine, 4th ed. Williams and Wilkins, Baltimore, Md.
Briefly, a variety of compounds were tested for antibacterial
activity against isolates of P. aeruginosa, K. pneumoniae, E. coli,
S. epidermidis and S. aureus in the MIC (minimum inhibitory
concentration assay under aerobic conditions using 96 well
polystyrene microtitre plates (Falcon 1177), and Mueller Hinton
broth at 37.degree. C. incubated for 24 h. (MHB was used for most
testing except C721 (S. pyogenes), which used Todd Hewitt broth,
and Haemophilus influenzae, which used Haemophilus test medium
(HTM)) Tests were conducted in triplicate. The results are provided
below in Table 1.
37TABLE 1 MINIMUM INHIBITORY CONCENTRATIONS OF THERAPEUTIC AGENTS
AGAINST VARIOUS GRAM NEGATIVE AND POSITIVE BACTERIA Bactrial Strain
P. aeruginosa K. pneumoniae E. coli S. aureus PAE/K799 ATCC13883
UB1005 ATCC25923 S. epidermidis S. pyogenes H187 C238 C498 C622
C621 C721 Wt wt wt wt wt wt Drug Gram - Gram - Gram - Gram + Gram +
Gram + doxorubicin 10.sup.-5 10.sup.-6 10.sup.-4 10.sup.-5
10.sup.-6 10.sup.-7 mitoxantrone 10.sup.-5 10.sup.-6 10.sup.-5
10.sup.-5 10.sup.-5 10.sup.-6 5-fluorouracil 10.sup.-5 10.sup.-6
10.sup.-6 10.sup.-7 10.sup.-7 10.sup.-4 methotrexate N 10.sup.-6 N
10.sup.-5 N 10.sup.-6 etoposide N 10.sup.-5 N 10.sup.-5 10.sup.-6
10.sup.-5 camptothecin N N N N 10.sup.-4 N hydroxyurea 10.sup.-4 N
N N N 10.sup.-4 cisplatin 10.sup.-4 N N N N N tubercidin N N N N N
N 2- N N N N N N mercaptopurine 6- N N N N N N mercaptopurine
cytarabine N N N N N N Activities are in Molar concentrations Wt =
wild type N = No activity
[1184] B. MIC of antibiotic-resistant bacteria
[1185] Various concentrations of the following compounds,
mitoxantrone, cisplatin, tubercidin, methotrexate, 5-fluorouracil,
etoposide, 2-mercaptopurine, doxorubicin, 6-mercaptopurine,
camptothecin, hydroxyurea and cytarabine were tested for
antibacterial activity against clinical isolates of a methicillin
resistant S. aureus and a vancomycin resistant pediococcus clinical
isolate in an MIC assay as described above. Compounds which showed
inhibition of growth (MIC value of <1.0.times.10-3) included:
mitoxantrone (both strains), methotrexate (vancomycin resistant
pediococcus), 5-fluorouracil (both strains), etoposide (both
strains), and 2-mercaptopurine (vancomycin resistant
pediococcus).
Example 57
Preparation of Release Buffer
[1186] The release buffer is prepared by adding 8.22 g sodium
chloride, 0.32 g sodium phosphate monobasic (monohydrate) and 2.60
g sodium phosphate dibasic (anhydrous) to a beaker. 1 L HPLC grade
water is added and the solution is stirred until all the salts are
dissolved. If required, the pH of the solution is adjusted to pH
7.4.+-.0.2 using either 0.1 N NaOH or 0.1 N phosphoric acid.
Example 58
Release Study to Determine Release Profile of the Therapeutic Agent
from a Coated Device
[1187] A sample of the therapeutic agent-loaded catheter is placed
in a 15 ml culture tube. 15 ml release buffer (Example 57) is added
to the culture tube. The tube is sealed with a TEFLON lined screw
cap and is placed on a rotating wheel in a 37.degree. C. oven. At
various time points, the buffer is withdrawn from the culture tube
and is replaced with fresh buffer. The withdrawn buffer is then
analyzed for the amount of therapeutic agent contained in this
buffer solution using HPLC.
[1188] All of the above U.S. patents, U.S. patent application
publications, U.S. patent applications, foreign patents, foreign
patent applications and non-patent publications referred to in this
specification and/or listed in the Application Data Sheet, are
incorporated herein by reference, in their entirety.
[1189] From the foregoing, it is appreciated that, although
specific embodiments of the invention have been described herein
for purposes of illustration, various modifications may be made
without deviating from the spirit and scope of the invention.
Accordingly, the invention is not limited except as by the appended
claims.
* * * * *
References